Provider Demographics
NPI:1124094487
Name:GRANGER, RONALD EUGENE (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:EUGENE
Last Name:GRANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WEEKS DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-3929
Mailing Address - Country:US
Mailing Address - Phone:336-598-5480
Mailing Address - Fax:336-598-5482
Practice Address - Street 1:107 WEEKS DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-3929
Practice Address - Country:US
Practice Address - Phone:336-598-5480
Practice Address - Fax:336-598-5482
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25298207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36728OtherBCBS
NC8936728Medicaid
NC36728OtherBCBS
C8673Medicare UPIN
NC07-50097OtherUHC
NC36728OtherBCBS
NC8936728Medicaid
NC136981OtherWELLPATH
NC562142486OtherBEECHSTREET
NC562142486V1OtherCIGNA