Basic Information
| Provider Information | |||||||||
| NPI: | 1588773824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANA | ||||||||
| FirstName: | GENEROSA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST STE SW200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
| FaxNumber: | 8563256777 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 COOPER PLZ | ||||||||
| Address2: | 400 HADDON AVE | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556322667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MA61041 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3K5922 | 01 | HEALTHNET | OTHER | 1024736 | 01 | HORIZON NJ HEALTH | OTHER | 110098669 | 01 | RR MEDICARE | OTHER | 5221609 | 05 | NJ | MEDICAID | 0475836 | 01 | AETNA | OTHER | 0730477000 | 01 | AMERIHEALTH, KEYSTONE, IBC | OTHER | 6847834 | 01 | CIGNA | OTHER | 502550 | 01 | PA | PENNSYLVANIA BLUE SHIELD | OTHER | 1303851 | 01 | UNITED HEALTHCARE | OTHER | P438092 | 01 | OXFORD | OTHER |