Provider Demographics
NPI:1013125350
Name:GRANT, RONALD ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALFRED
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:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-0748
Mailing Address - Country:US
Mailing Address - Phone:203-629-3880
Mailing Address - Fax:203-262-6593
Practice Address - Street 1:45 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5438
Practice Address - Country:US
Practice Address - Phone:203-629-3880
Practice Address - Fax:203-262-6593
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT201352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry