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General NPI Number Information
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NPI Number | 1639178122
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Entity Type | Individual
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Provider Name | MICHAEL GRILLON MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 20486 MARKET STREET
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City | ONANCOCK
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State | VA
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Zip | 23417
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Country | US
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Telephone | 757-302-2700
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Fax | 757-787-9262
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Provider Business Mailing Address
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Address Line | 8262 ATLEE RD SUITE 205
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-1816
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Country | US
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Telephone | 804-559-0194
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Fax | 804-559-0198
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101055534
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101055534
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License Number State | VA
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