Provider Demographics
NPI:1245337062
Name:GRANT, CAROL A (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FORSTER AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2317
Mailing Address - Country:US
Mailing Address - Phone:866-633-8255
Mailing Address - Fax:718-794-1619
Practice Address - Street 1:HUTCHINSON METRO CENTER
Practice Address - Street 2:1200 WATERS PLACE STE. M103
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:866-633-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199289207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology