Provider Demographics
NPI:1154600534
Name:BRAME, GRANT RICHARD (MSPAS, PA-C)
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:RICHARD
Last Name:BRAME
Suffix:
Gender:M
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:618 PLEASANTVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3312
Practice Address - Country:US
Practice Address - Phone:740-681-9020
Practice Address - Fax:740-681-9112
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.003315RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067393Medicaid
OHH080710Medicare PIN