Provider Demographics
NPI:1740399419
Name:GRANT, JOHN LELAND (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LELAND
Last Name:GRANT
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 1:3909 STONEBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321
Mailing Address - Country:US
Mailing Address - Phone:757-670-5446
Mailing Address - Fax:
Practice Address - Street 1:3909 STONEBRIDGE CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321
Practice Address - Country:US
Practice Address - Phone:757-670-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038829207T00000X
NC29113207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery