Provider Demographics
NPI:1861557928
Name:GRANT, CAROL R (MD LLC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:R
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10743 NARCOOSSEE RD
Mailing Address - Street 2:STE# A8-208
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6944
Mailing Address - Country:US
Mailing Address - Phone:407-592-1550
Mailing Address - Fax:
Practice Address - Street 1:10743 NARCOOSSEE RD
Practice Address - Street 2:STE# A8-208
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6944
Practice Address - Country:US
Practice Address - Phone:407-592-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME715692083X0100X
FLME 071569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG19739Medicare UPIN