Provider Demographics
NPI:1851477566
Name:M. GRETCHEN GRANT, MD
Entity Type:Organization
Organization Name:M. GRETCHEN GRANT, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:GRETCHEN
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-371-3391
Mailing Address - Street 1:989 ROUTE 146 STE 300
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3647
Mailing Address - Country:US
Mailing Address - Phone:518-371-3391
Mailing Address - Fax:
Practice Address - Street 1:989 ROUTE 146 STE 300
Practice Address - Street 2:SUITE 303
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3647
Practice Address - Country:US
Practice Address - Phone:518-371-3391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142726207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty