Provider Demographics
NPI:1790781003
Name:GRANT, CATHERINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:E
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GARTON PLZ
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-2128
Mailing Address - Country:US
Mailing Address - Phone:304-269-6620
Mailing Address - Fax:304-269-4593
Practice Address - Street 1:25 GARTON PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2128
Practice Address - Country:US
Practice Address - Phone:304-269-6620
Practice Address - Fax:304-269-4593
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0052065000Medicaid
WV0052065000Medicaid
WVB42770Medicare UPIN