Provider Demographics
NPI:1538163928
Name:GOLDING-GRANADO, LISA M (MD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:GOLDING-GRANADO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:179 AVENUE AT THE COMMONS
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-380-6010
Mailing Address - Fax:732-380-6012
Practice Address - Street 1:GOLDING GRANADO MEDICAL ASSOCIATES
Practice Address - Street 2:179 AVENUE AT THE COMMONS, SUITE 101
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4804
Practice Address - Country:US
Practice Address - Phone:732-380-6010
Practice Address - Fax:732-264-5554
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2023-04-26
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Provider Licenses
StateLicense IDTaxonomies
NJMA70300207R00000X
NJ25MA07030000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8254605Medicaid
NJ8254605Medicaid
NJH19402Medicare UPIN