Provider Demographics
NPI:1407972169
Name:CATHAL P GRANT MD PA
Entity Type:Organization
Organization Name:CATHAL P GRANT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-354-7268
Mailing Address - Street 1:1604 HOSPITAL PKWY
Mailing Address - Street 2:STE. 507
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6986
Mailing Address - Country:US
Mailing Address - Phone:817-354-7268
Mailing Address - Fax:817-354-9930
Practice Address - Street 1:1604 HOSPITAL PKWY
Practice Address - Street 2:STE. 507
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6986
Practice Address - Country:US
Practice Address - Phone:817-354-7268
Practice Address - Fax:817-354-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE38627Medicare UPIN
TX00F55ZMedicare ID - Type UnspecifiedCATHAL P GRANT MD PA