Provider Demographics
NPI:1144274994
Name:GRANDE, NICHOLAS ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:GRANDE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2411 CROFTON LN STE 7B
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1323
Mailing Address - Country:US
Mailing Address - Phone:410-451-9870
Mailing Address - Fax:410-451-9872
Practice Address - Street 1:2411 CROFTON LN STE 14A
Practice Address - Street 2:SUITE 14A
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1336
Practice Address - Country:US
Practice Address - Phone:410-451-9870
Practice Address - Fax:410-451-9872
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01909 PT111N00000X
MDS01909-PT111NI0013X, 111NN0400X, 111NX0100X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD269P572GMedicare PIN