Healthcare Provider Details

I. General information

NPI: 1285016311
Provider Name (Legal Business Name): STANLEY BRANDON GROVER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 02/19/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 CARROLL STREET
LEBANON VA
24266
US

IV. Provider business mailing address

58 CARROLL ST
LEBANON VA
24266
US

V. Phone/Fax

Practice location:
  • Phone: 276-883-8000
  • Fax: 276-883-8101
Mailing address:
  • Phone: 276-883-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102205572
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101021975
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO0000003381
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102205572
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO0000003381
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: