Individual
DR. RUSS D. GRANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
659 TOWER AVE, HARTFORD, CT 06112-1259
(860) 763-7600
Mailing address
104 RIDGEWOOD RD, WEST HARTFORD, CT 06107-2927
(510) 928-5848
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
G50400
CA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
067712
CT
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
G50400
CA
207R00000X
Internal Medicine Physician
067712
CT
207R00000X
Internal Medicine Physician
G50400
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G504000
—
CA
Enumeration date
11/01/2006
Last updated
03/19/2025
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