Provider Demographics
NPI:1376644971
Name:GRANADOS, ERIK GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:GABRIEL
Last Name:GRANADOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14419 NORTH SLOPE STREET
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120
Mailing Address - Country:US
Mailing Address - Phone:703-988-0319
Mailing Address - Fax:703-369-3118
Practice Address - Street 1:9384 FORESTWOOD LANE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-369-2999
Practice Address - Fax:703-369-3118
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101221378208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00670558Medicaid
VA00670558Medicaid