Individual
MICHAEL A GRANOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11711 LIVINGSTON RD, FT WASHINGTON, MD 20744-5151
(301) 203-2250
Mailing address
PO BOX 500, MARSHALL, VA 20116-0500
(301) 686-9010
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
D0046947
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017158500
—
DC
05
—
550300100
—
MD
01
—
76881001
MARYLAND BLUE SHIELD
MD
01
—
H9140003
DC BLUE SHIELD
DC
Enumeration date
03/31/2006
Last updated
02/09/2012
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