Individual
MARISSA C. GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
410 W 10TH AVE, COLUMBUS, OH 43210-1240
(614) 293-8487
(614) 293-8153
Mailing address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(937) 257-0000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34.016761.MIL
OH
208D00000X
General Practice Physician
0102206367
VA
Other
Enumeration date
05/08/2019
Last updated
03/18/2026
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