Provider Demographics
NPI:1629643515
Name:RICHARDSON, GRANT
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 TANNEHILL ST
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:724-413-5805
Mailing Address - Fax:
Practice Address - Street 1:UPMC MCKEESPORT LATTERMAN FAMILY HEALTH
Practice Address - Street 2:2347 FIFTH AVENUE
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132
Practice Address - Country:US
Practice Address - Phone:412-673-5504
Practice Address - Fax:412-673-2150
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program