Provider Demographics
NPI:1215223177
Name:GRANT, ALISON THERESE (MD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:THERESE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 ROUTE 70 EAST
Mailing Address - Street 2:STE 210
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2013
Mailing Address - Country:US
Mailing Address - Phone:215-662-8978
Mailing Address - Fax:215-662-5940
Practice Address - Street 1:1865 ROUTE 70 E STE 210
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2005
Practice Address - Country:US
Practice Address - Phone:856-427-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10274300207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201235530Medicaid
P01424350OtherRR MEDICARE
P01424350OtherRR MEDICARE