Individual
ANTONIO M GRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
46 FAIRVIEW AVE STE 221, SKOWHEGAN, ME 04976-1481
(207) 474-6945
(207) 474-6933
Mailing address
PO BOX 468, SKOWHEGAN, ME 04976-0468
(207) 858-8353
(207) 474-9261
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
09565
TN
207RG0100X
Gastroenterology Physician
35.143494
OH
207RG0100X
Gastroenterology Physician
9565
TN
207RG0100X
Gastroenterology Physician
Primary
MD23009
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100014907
MEDICARE RR
TN
01
—
10074063
AMERIGROUP TNCARE AND AMERIVANTAGE MCR ADVANTAGE
TN
01
—
104697
UNITED HEALTH CARE
TN
01
—
1100315241
USA PPO/GEHA
TN
01
—
12079645
MULTIPLAN/PHCS
TN
01
—
1416751
CIGNA
TN
05
—
1507235
—
TN
01
—
1629728
COVENTRY/FIRST HEALTH
TN
01
—
3164315
BLUE CROSS OF TN
TN
01
—
378643
USA - MCO
TN
01
—
4066743
AETNA
TN
05
—
64746449
—
KY
05
—
Q006396
—
TN
Enumeration date
06/07/2006
Last updated
11/04/2021
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