Provider Demographics
NPI:1598088528
Name:ALFRED GRANSON JR MD LLC
Entity Type:Organization
Organization Name:ALFRED GRANSON JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GRETZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-589-9700
Mailing Address - Street 1:70 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-2831
Mailing Address - Country:US
Mailing Address - Phone:419-589-9700
Mailing Address - Fax:419-589-2731
Practice Address - Street 1:70 MADISON RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-2831
Practice Address - Country:US
Practice Address - Phone:419-589-9700
Practice Address - Fax:419-589-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2136683Medicaid
OHG94600Medicare UPIN