Individual
MARY E GRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
107 KOONTZ AVE. STE. 200, CLENDENIN, WV 25045
(304) 548-7272
(304) 548-7149
Mailing address
PO BOX 70, DAWES, WV 25054
(304) 734-2040
(304) 734-2047
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00616
WV
Other
Enumeration date
03/14/2006
Last updated
05/21/2020
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