Provider Demographics
NPI:1902928344
Name:RAYMOND C. GRANDON, M.D.
Entity Type:Organization
Organization Name:RAYMOND C. GRANDON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-234-4187
Mailing Address - Street 1:131 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-1027
Mailing Address - Country:US
Mailing Address - Phone:717-234-4187
Mailing Address - Fax:717-234-0892
Practice Address - Street 1:131 STATE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1027
Practice Address - Country:US
Practice Address - Phone:717-234-4187
Practice Address - Fax:717-234-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021226L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA55734Medicare ID - Type Unspecified
PAD68193Medicare UPIN