Provider Demographics
NPI:1528551041
Name:GRANOFF, MITCHELL (DO)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:GRANOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LEAVY DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-472-7233
Mailing Address - Fax:603-472-9188
Practice Address - Street 1:25 LEAVY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-472-7233
Practice Address - Fax:603-472-9188
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21764207Q00000X
NHRT-3294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine