Provider Demographics
NPI:1679641302
Name:DE GRANDCOURT, ROBERT FANCHER
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:FANCHER
Last Name:DE GRANDCOURT
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 1:405 OLD ROCK ROAD
Mailing Address - Street 2:LAKE COUNTRY MOBILITY
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-3211
Mailing Address - Country:US
Mailing Address - Phone:434-374-0920
Mailing Address - Fax:434-374-9285
Practice Address - Street 1:405 OLD ROCK ROAD
Practice Address - Street 2:LAKE COUNTRY MOBILITY
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927-3211
Practice Address - Country:US
Practice Address - Phone:434-374-0920
Practice Address - Fax:434-374-9285
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies