Healthcare Provider Details

I. General information

NPI: 1972821593
Provider Name (Legal Business Name): JON ANDREW GRAMMES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 KEMPSVILLE RD STE 204
NORFOLK VA
23502-3927
US

IV. Provider business mailing address

844 KEMPSVILLE RD STE 204
NORFOLK VA
23502-3927
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-0700
  • Fax: 757-261-0701
Mailing address:
  • Phone: 757-261-0700
  • Fax: 757-261-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0102202645
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0102202645
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: