Provider Demographics
NPI:1366236085
Name:GRANT, ELLIOTT JEROME (RD/LDN)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:JEROME
Last Name:GRANT
Suffix:
Gender:M
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BENNINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8667
Mailing Address - Country:US
Mailing Address - Phone:919-667-5379
Mailing Address - Fax:
Practice Address - Street 1:113 BENNINGTON PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8667
Practice Address - Country:US
Practice Address - Phone:919-667-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC007519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered