Provider Demographics
NPI:1639138209
Name:MUSSMAN, GRANT MCCANN (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:MCCANN
Last Name:MUSSMAN
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 1:7777 YANKEE ROAD ML 16026
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-3500
Mailing Address - Country:US
Mailing Address - Phone:513-803-9649
Mailing Address - Fax:513-803-9659
Practice Address - Street 1:7777 YANKEE ROAD ML 16026
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-3500
Practice Address - Country:US
Practice Address - Phone:513-803-9649
Practice Address - Fax:513-803-9659
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH90067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010181127Medicaid