MEDICARE: DR. RICHARD LAWRENCE GRANVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0021609	MD

General Provider Information

NPI Number	:	1952387144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LAWRENCE GRANVILLE

Provider Business Mailing Address
First Line	:	5517 ALTA VISTA RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-1612
Country	:	US
Telephone Number	:	301-897-0343
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 E WEST HWY
Second Line	:	SUITE 6-100
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3225
Country	:	US
Telephone Number	:	301-295-8129
Fax Number	:	301-295-7217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/08/2007

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