Provider Demographics
NPI:1952372351
Name:GRANT, IAIN L (MD)
Entity Type:Individual
Prefix:
First Name:IAIN
Middle Name:L
Last Name:GRANT
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 1:1810 MACKENZIE DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2967
Mailing Address - Country:US
Mailing Address - Phone:614-273-2234
Mailing Address - Fax:614-273-2255
Practice Address - Street 1:974 BETHEL RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2467
Practice Address - Country:US
Practice Address - Phone:614-273-1014
Practice Address - Fax:614-273-1015
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073998G207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2169504Medicaid
0879591Medicare ID - Type Unspecified