Provider Demographics
NPI:1881993103
Name:GRANT, ABIGAIL RUTH (MD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:RUTH
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 1:325 NINTH AVENUE
Mailing Address - Street 2:BOX 359774
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-744-9500
Mailing Address - Fax:206-744-9862
Practice Address - Street 1:325 NINTH AVENUE
Practice Address - Street 2:BOX 359774
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-744-9500
Practice Address - Fax:206-744-9862
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60224540208000000X
WAMD60459551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics