Provider Demographics
NPI:1598830903
Name:GRANATA, LAUREN ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ROSE
Last Name:GRANATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:ROSE
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5544 GREENWICH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6563
Mailing Address - Country:US
Mailing Address - Phone:757-466-0089
Mailing Address - Fax:757-466-8017
Practice Address - Street 1:5544 GREENWICH RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6563
Practice Address - Country:US
Practice Address - Phone:757-466-0089
Practice Address - Fax:757-466-8017
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012429842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00616142OtherRR MEDICARE
VA10032520OtherOPTIMA
VA139178OtherBCBS
NC5910265Medicaid
VA10032520OtherSENTARA
VAMC10101Medicare PIN