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Individual
MARK ELLIOTT GRANOFF
Active
Individual
MARK ELLIOTT GRANOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G30036
CA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
G30036
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G300360
BLUE SHIELD
CA
01
—
110021538
RAILROAD MEDICARE
CA
01
—
4042708
AETNA
CA
Enumeration date
07/03/2006
Last updated
06/20/2008
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