Provider Demographics
NPI:1952484149
Name:GRANTHAM, CHRISTOPHER ASHBY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ASHBY
Last Name:GRANTHAM
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 1:9 GRAMATAN CT
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3015
Mailing Address - Country:US
Mailing Address - Phone:914-793-3552
Mailing Address - Fax:
Practice Address - Street 1:183RD ST. & 3RD AVE.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2594
Practice Address - Country:US
Practice Address - Phone:718-960-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170931-1207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY170931-1OtherLICENCE NUMBER
NJ0246913Medicaid
NJ800012YCCMMedicare PIN