Provider Demographics
NPI:1992711683
Name:GRANT, STEPHEN A (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:989 ROUTE 146
Practice Address - Street 2:BLDG.200
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3646
Practice Address - Country:US
Practice Address - Phone:518-383-0891
Practice Address - Fax:518-383-1662
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY136171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000401094001OtherBSNENY
NY10000802OtherCDPHP
NY00884226Medicaid
NY08116OtherMVP
NY47336OtherGHI/HMO
NY071009000031OtherFIDELIS
NY200225OtherSENIOR WHOLE HEALTH
NY7451113OtherAETNA
NY01V511OtherEMPIRE BC
NY47336OtherGHI/HMO
NY01V511OtherEMPIRE BC