Provider Demographics
NPI:1992712301
Name:GOLDEN, GRANT (MD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:GOLDEN
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 1:3730 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1732
Mailing Address - Country:US
Mailing Address - Phone:716-633-8675
Mailing Address - Fax:
Practice Address - Street 1:3730 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1732
Practice Address - Country:US
Practice Address - Phone:716-633-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14563512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026747601OtherUNIVERA
000506026004OtherBLUE SHIELD OF WESTERN NY
000267U7602OtherUNIVERA
NY01257010Medicaid
149932FFOtherPREFERRED CARE
300137709OtherRAILROAD MEDICARE
5608638OtherINDEPENDANT HEALTH
1456359WOtherWORKERS COMPENSATION
000506026002OtherBLUE SHIELD OF WESTERN NY
NY01257010Medicaid