Provider Demographics
NPI:1518978782
Name:GRANDE, DAVID THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:GRANDE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3701 MARKET STREET
Mailing Address - Street 2:7TH FLOOR, SUITE 741
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5502
Mailing Address - Country:US
Mailing Address - Phone:215-349-5200
Mailing Address - Fax:215-615-0038
Practice Address - Street 1:3701 MARKET STREET
Practice Address - Street 2:7TH FLOOR, SUITE 741
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5502
Practice Address - Country:US
Practice Address - Phone:215-349-5200
Practice Address - Fax:215-615-0038
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD421398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine