Provider Demographics
NPI:1780778589
Name:GRINSPAN, RANDY N (DO)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:N
Last Name:GRINSPAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 WINFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-4363
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1820
Practice Address - Country:US
Practice Address - Phone:610-278-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004787-L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009707660010OtherPROMISE
PA0033057000OtherBS
PA0033057000OtherKEYSTONE
PA30040006OtherKEYSTONE MERCY
PA003305700OtherHIGHMARK BS
PA00970766Medicaid
PA0033057000OtherBS