Charles Frederick Grannum, MD

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

040024 Issued in NY

Practice address

1536 Bedford Ave
Brooklyn, NY 11216-4117

Phone

(800) 376-5566

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Interfaith Radiology

  • Diagnostic Radiology Physician
  • Brooklyn, NY
  • NPI 1366527772
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205904208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29889",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100879889",
            "telephone_number": "800-376-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 BEDFORD AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112164117",
            "telephone_number": "800-376-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANNUM",
        "first_name": "CHARLES",
        "middle_name": "FREDERICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NY",
            "license": "040024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "040024",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elena Granger
• Alyssa Marie Granice, LMSW
• Tanya D Granick, MA
• Meghan Cass Graniello, LCSW
• Tatyana Granik, PHARM D.
• Roger Grannum, DDS
• Granny Homecare LLC
• Dean Yehoshua Granot
• Graig V Granovsky, DC
• Megan Granski, PHD

• Prosthodontics in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Prosthodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.