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General NPI Number Information
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NPI Number | 1316941222
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Entity Type | Individual
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Provider Name | MICHAEL GRUNDEL ISON M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-776-4001
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Fax | 703-776-7113
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Provider Business Mailing Address
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Address Line | 16223 COLUMBUS AVE
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City | DERWOOD
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State | MD
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Zip | 20855-2188
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Country | US
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Telephone | 617-306-1260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 221230
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 0101230684
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License Number State | VA
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