Provider Demographics
NPI:1568588218
Name:GRANACHER, ROBERT P JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:GRANACHER
Suffix:JR
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 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE A 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504
Mailing Address - Country:US
Mailing Address - Phone:859-277-5213
Mailing Address - Fax:859-277-5413
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE A 400
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-277-5213
Practice Address - Fax:859-277-5413
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169882084F0202X, 2084N0400X, 2084P0805X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64169881Medicaid
KY1183301Medicare ID - Type Unspecified
KY64169881Medicaid