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Contact Information

ANTONIO M GRANDA, MD
46 FAIRVIEW AVE STE 221
SKOWHEGAN, ME04976-1481
 Phone: 207-474-6945
 Fax: 207-474-6933
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for ANTONIO M GRANDA · (Male)

NPI Number 1780624023
Status Active
Credentials MD
Entity Individual
Enumeration date 06/07/2006
Last updated 11/04/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • ME License # MD23009
  • OH License # 35.143494
  • TN License # 09565
  • TN License # 9565
  • KY Medicaid 64746449
  • TN Medicaid 1507235
  • TN Medicaid Q006396
  • TN Other 4066743 AETNA
  • TN Other 10074063 AMERIGROUP TNCARE AND AMERIVANTAGE MCR ADVANTAGE
  • TN Other 3164315 BLUE CROSS OF TN
  • TN Other 1416751 CIGNA
  • TN Other 1629728 COVENTRY/FIRST HEALTH
  • TN Other 100014907 MEDICARE RR
  • TN Other 12079645 MULTIPLAN/PHCS
  • TN Other 104697 UNITED HEALTH CARE
  • TN Other 378643 USA - MCO
  • TN Other 1100315241 USA PPO/GEHA
Hospital affiliation(s)
  • GOOD SAMARITAN HOSPITAL - (Acute Care)
    375 DIXMYTH AVENUE
    CINCINNATI, OH 45220
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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