Kelley, Grant Gordon

Kelley, Grant Gordon is an individual health care provider with primary practice located at 301 Prospect Ave Hospital Internists, Syracuse NY 13203-1807. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism. Allopathic & Osteopathic Physicians / Hospitalist is his primary health care specialty. Kelley, Grant Gordon can be contacted via phone (315) 448-5704.

Contact Information

Primary practice address
301 Prospect Ave Hospital Internists Syracuse NY 13203-1807
Phone: (315) 448-5704
Fax: (315) 423-6853
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 205703 New York
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 205703 New York

Profile Details

NPI number 1922259845
LBN Legal business name Kelley, Grant Gordon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 9th, 2008
Last updated Jul 12th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922259845 NPPES
New York MEDICAID 01724529

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