Organization Name: | GRANITE MEDICAL PC |
NPI Number: | 1043549678 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAWRENCE P WEAN (MEDICAL DOCTOR) |
Mailing Address: | 1098 W Baltimore Pike Rmh Opp Ste 3304 Media |
State: | PA US |
Postal Code: | 190635139 |
Phone Number: | 6108919640 |
Fax Number: | 6108919644 |
NPI Enumeration Date: | 12/10/2009 |
NPI Last Update Date: | 12/10/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |