Provider Demographics
NPI:1447958145
Name:GRANT, RYAN LEE
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:GRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5139
Mailing Address - Country:US
Mailing Address - Phone:978-241-0537
Mailing Address - Fax:
Practice Address - Street 1:727 LAFAYETTE RD STE 1A
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4255
Practice Address - Country:US
Practice Address - Phone:978-241-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)