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Individual

ROBERT GRANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1144 N ROAD ST STE 200, ELIZABETH CITY, NC 27909-3473
(252) 384-2360
(252) 384-2359
Mailing address
1144 N ROAD ST STE 200, ELIZABETH CITY, NC 27909-3473
(252) 384-2360
(252) 384-2359

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101250123
VA
207X00000X
Orthopaedic Surgery Physician
26510
KY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
0101250123
VA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
2003-01234
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000048618
ANTHEM BCBS
KY
01
200016599
RR MEDICARE
KY
01
4229925
AETNA
KY
05
65939795
KY
Enumeration date
08/01/2006
Last updated
04/23/2021
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