Provider Demographics
NPI:1992791016
Name:GRANTHAM, ANNE SENIOW (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:SENIOW
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1587 BOETTLER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7823
Mailing Address - Country:US
Mailing Address - Phone:330-896-3033
Mailing Address - Fax:330-896-5692
Practice Address - Street 1:571 E TURKEYFOOT LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-4122
Practice Address - Country:US
Practice Address - Phone:330-896-3033
Practice Address - Fax:330-896-5692
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0768807Medicaid
OH080175930OtherRAILROAD MEDICARE
E95962Medicare UPIN
OHGR0697795Medicare ID - Type Unspecified
OH1322280001Medicare NSC