Provider Demographics
NPI:1912903386
Name:GRAINGER, ANDREW V (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:V
Last Name:GRAINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 JASONWAY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4359
Mailing Address - Country:US
Mailing Address - Phone:614-442-3130
Mailing Address - Fax:614-442-3150
Practice Address - Street 1:810 JASONWAY AVE STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4359
Practice Address - Country:US
Practice Address - Phone:614-442-3130
Practice Address - Fax:614-442-3145
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.076121207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338250Medicaid
OHP00202789OtherRAILROAD MEDICARE
OH0410220OtherUHC
OH000000356818OtherANTHEM
OH99162OtherNATIONWIDE
OHH68148Medicare UPIN
OH4113288Medicare ID - Type Unspecified