Individual
RONN A. GRANDIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12075 JERRYS RUN RD, APPLE GROVE, WV 25502
(304) 546-0854
Mailing address
PO BOX B, FRAZIERS BOTTOM, WV 25082-0251
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
18530
WV
208600000X
Surgery Physician
35-06-1980
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000181638
UNISON MEDICAID
OH
01
—
000000211735
ANTHEM BCBS
—
01
—
000901380
MOUNTAIN STATE BCBS
—
01
—
0848051
MOLINA MEDICAID
OH
05
—
0848051
—
OH
05
—
1720032238
—
WV
01
—
310917085052
CARESOURCE MEDICAID
OH
Enumeration date
05/20/2006
Last updated
10/31/2019
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