Individual
MICA DIANNA GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2041 GEORGIA AVENUE, NW, 1M05, WASHINGTON, DC 20060-0001
(202) 865-1354
Mailing address
2041 GEORGIA AVE NW STE 1M05, WASHINGTON, DC 20060-0001
(202) 865-1354
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
C1-0011207
DE
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD210002279
DC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD453773
PA
Other
Enumeration date
06/07/2011
Last updated
02/02/2023
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