Provider Demographics
NPI:1548229586
Name:GRANA, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:GRANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ASHVILLE AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:919-233-1311
Mailing Address - Fax:919-233-1685
Practice Address - Street 1:400 ASHVILLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6134
Practice Address - Country:US
Practice Address - Phone:919-233-1311
Practice Address - Fax:919-233-1685
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936748Medicaid
NCF99748Medicare UPIN
NC2227519Medicare ID - Type Unspecified