Individual
MAURICE R GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 STADIUM DR, MORGANTOWN, WV 26506-7911
(304) 598-4000
(304) 293-6963
Mailing address
PO BOX 897, MORGANTOWN, WV 26507-0897
(304) 293-5033
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
22854
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009377
—
WV
01
—
P00416431
RAILROAD MEDICARE
WV
Enumeration date
07/16/2007
Last updated
11/16/2007
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