Provider Demographics
NPI:1558435438
Name:GRANGER, ELDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELDER
Middle Name:
Last Name:GRANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 FAIRFAX DR
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-2121
Mailing Address - Country:US
Mailing Address - Phone:703-681-1731
Mailing Address - Fax:703-681-3665
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:STE GC11
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-681-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5837207RH0003X
CO34494207RH0003X
TXK0787207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology