Provider Demographics
NPI:1558473017
Name:GRANGER, MARY MEAGHAN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MEAGHAN
Last Name:GRANGER
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-4007
Practice Address - Fax:682-885-3914
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1870207RH0003X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2113909OtherFIRSTHEALTH PIN
TX10026862OtherAMERIGROUP PIN
TX145075105Medicaid
TX129416100OtherFIRSTCARE PIN
TX7597316OtherAETNA PIN
TX0536387OtherCIGNA PIN
TX137345810Medicaid
TX145075107Medicaid
1750369203OtherGRP NPI NUMBER
TX8F0031OtherBCBSTX IND PIN
TX2106396OtherUHC PIN
TX00U87ZOtherBCBSTX GRP PIN
TX124206OtherSUPERIOR PIN
TX140442852Medicaid
TX129416100OtherFIRSTCARE PIN
TX137345810Medicaid
TX00U87ZOtherBCBSTX GRP PIN