Provider Demographics
NPI:1598884041
Name:GRANDISON, GARFIELD ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:GARFIELD
Middle Name:ALEXANDER
Last Name:GRANDISON
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:613 23RD ST STE 430
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2885
Practice Address - Country:US
Practice Address - Phone:606-408-8200
Practice Address - Fax:606-408-6291
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132779207RG0100X
KY42842207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100207000Medicaid
MNP00665875OtherMEDICARE RAILROAD
OH0066758Medicaid
WV3810023286Medicaid
WV3810023286Medicaid
MN110012206Medicare PIN