Provider Demographics
NPI:1285846659
Name:DIAZGRANADOS, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DIAZGRANADOS
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 1:2324 W JOPPA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4615
Mailing Address - Country:US
Mailing Address - Phone:410-583-2623
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:10CRC/1-3449 MSC 1108
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1108
Practice Address - Country:US
Practice Address - Phone:301-496-7515
Practice Address - Fax:301-402-0445
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4307442084P0800X, 208U00000X
MDD745882084P0800X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology