Active NPI
Leroy Grant, PHYSICIANS ASSISTANT
- Medical Physician Assistant
- Silver Spring, MD
National Provider Identifier
1831445402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA165
- Practice address
- 12215 Dalewood Dr
Silver Spring, MD 20902-1119 - Phone
- (301) 946-0806
- Fax
- (301) 946-0806
- NPI assigned
- Jul 31, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA165 | DC | Primary |
Addresses
Primary practice location
12215 Dalewood Dr
Silver Spring, MD 20902-1119
Mailing address
12215 Dalewood Dr
Silver Spring, MD 20902-1119
Phone (301) 946-0806
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA165 | DC | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343692800000",
"number": "1831445402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12215 DALEWOOD DR",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209021119",
"telephone_number": "301-946-0806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12215 DALEWOOD DR",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209021119",
"telephone_number": "301-946-0806",
"fax_number": "301-946-0806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "LEROY",
"name_prefix": "Mr.",
"credential": "PHYSICIANS ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-31",
"last_updated": "2012-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "DC",
"license": "PA165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Silver Spring, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.