Provider Demographics
NPI:1871805523
Name:GRANT, SCOTT BRYAN (MD, M BIOETHICS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRYAN
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD, M BIOETHICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3453
Mailing Address - Country:US
Mailing Address - Phone:248-259-4548
Mailing Address - Fax:888-372-9871
Practice Address - Street 1:826 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4459
Practice Address - Country:US
Practice Address - Phone:610-983-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288213208600000X
PAMD479667208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04833309Medicaid
NJI20150312001346OtherMEDICARE PECOS
NJ0454451Medicaid