Provider Demographics
NPI:1831305226
Name:GRANATA, ATTILIO VINCENT (MD, MBA, FACP)
Entity Type:Individual
Prefix:DR
First Name:ATTILIO
Middle Name:VINCENT
Last Name:GRANATA
Suffix:
Gender:M
Credentials:MD, MBA, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WILDROSE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-1837
Mailing Address - Country:US
Mailing Address - Phone:203-530-1451
Mailing Address - Fax:
Practice Address - Street 1:130 WILDROSE RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-1837
Practice Address - Country:US
Practice Address - Phone:203-530-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE31385Medicare UPIN