Provider Demographics
NPI:1508866229
Name:GRANITE, DAVID SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMUEL
Last Name:GRANITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7500 HANOVER PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2009
Mailing Address - Country:US
Mailing Address - Phone:301-474-2141
Mailing Address - Fax:301-345-3874
Practice Address - Street 1:7500 HANOVER PKWY STE 206
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2009
Practice Address - Country:US
Practice Address - Phone:301-474-2141
Practice Address - Fax:301-345-3874
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0017572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD60370006OtherBCBS OF NATL CAP
MD1031290OtherAFFORDABLE/1ST HEALTH
MD4051960OtherAETNA PPO
MD41447001OtherBCBS OF MD
MD522040780OtherPHCS
MD7975077OtherCIGNA
MD246432OtherMAMSI
MD522040780OtherONE HEALTH
MD080137996OtherMEDICARE RR
MD735966OtherAETNA HMO
MD18061012OtherUNITED HEALTH
MD302151300Medicaid
MD60370006OtherBCBS OF NATL CAP