Individual
MARK JOHN GRANADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9109 MIDDLEFORD ROAD, SEAFORD, DE 19973
(302) 629-9483
(302) 628-3977
Mailing address
PO BOX 913, SEAFORD, DE 19973-0913
(302) 629-9483
(302) 628-3977
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C1-0001675
DE
207RP1001X
Pulmonary Disease Physician
Primary
CI0001675
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000128601
—
DE
Enumeration date
12/18/2006
Last updated
11/29/2011
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