Provider Demographics
NPI:1013570811
Name:GRANTHAM, TROY SIMON (MD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:SIMON
Last Name:GRANTHAM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:109 W 27TH ST RM 5S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6208
Mailing Address - Country:US
Mailing Address - Phone:833-351-8255
Mailing Address - Fax:888-815-3583
Practice Address - Street 1:3223 S LOOP 289 STE 600 PRIVATE OFFICE 630
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1372
Practice Address - Country:US
Practice Address - Phone:833-351-8255
Practice Address - Fax:888-815-3583
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS323392084P0800X
CODR.00715292084P0800X
NY3248742084P0800X
TXT23842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry