Provider Demographics
NPI:1588773824
Name:GRANA, GENEROSA (MD)
Entity type:Individual
Prefix:
First Name:GENEROSA
Middle Name:
Last Name:GRANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE SW200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:856-325-6777
Practice Address - Street 1:2 COOPER PLZ
Practice Address - Street 2:400 HADDON AVE
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:855-632-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61041207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3K5922OtherHEALTHNET
1024736OtherHORIZON NJ HEALTH
110098669OtherRR MEDICARE
NJ5221609Medicaid
0475836OtherAETNA
0730477000OtherAMERIHEALTH, KEYSTONE, IBC
6847834OtherCIGNA
PA502550OtherPENNSYLVANIA BLUE SHIELD
1303851OtherUNITED HEALTHCARE
P438092OtherOXFORD
0475836OtherAETNA
1303851OtherUNITED HEALTHCARE