Healthcare Provider Details

I. General information

NPI: 1649271750
Provider Name (Legal Business Name): RAVNEET GREWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE SUITE 107
LANSDOWNE VA
20176-8452
US

IV. Provider business mailing address

19415 DEERFIELD AVE SUITE 107
LANSDOWNE VA
20176-8452
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-6030
  • Fax: 703-729-1446
Mailing address:
  • Phone: 703-729-6030
  • Fax: 703-729-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101220924
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: