Provider Demographics
NPI:1023089075
Name:GRANSTON, TRACI SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:SUZANNE
Last Name:GRANSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRACI
Other - Middle Name:SUZANNE
Other - Last Name:BARTHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4011 TALBOT RD S STE 300
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5791
Mailing Address - Country:US
Mailing Address - Phone:425-656-5060
Mailing Address - Fax:425-656-5047
Practice Address - Street 1:4011 TALBOT RD S STE 300
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5791
Practice Address - Country:US
Practice Address - Phone:425-656-5060
Practice Address - Fax:425-656-5047
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039700207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1090604Medicaid
WA160279OtherWA LABOR & INDUSTRIES