Provider Demographics
NPI:1508037078
Name:GRANT, DARCY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DARCY
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1300 BANCROFT AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3201
Mailing Address - Country:US
Mailing Address - Phone:510-483-2600
Mailing Address - Fax:510-483-2605
Practice Address - Street 1:1300 BANCROFT AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5147
Practice Address - Country:US
Practice Address - Phone:510-483-2600
Practice Address - Fax:510-483-2605
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102856208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics