Provider Demographics
NPI:1902081508
Name:GRANT, DARRELL (DBA(THE MED DOCTORS))
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:DBA(THE MED DOCTORS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 HOOVER LAKE CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1919
Mailing Address - Country:US
Mailing Address - Phone:866-531-0822
Mailing Address - Fax:866-531-0822
Practice Address - Street 1:1119 HOOVER LAKE CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1919
Practice Address - Country:US
Practice Address - Phone:866-531-0822
Practice Address - Fax:866-531-0822
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNONE REQUIRED332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2111646Medicaid