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General NPI Number Information
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NPI Number | 1851830178
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Entity Type | Organization
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Legal Business Name | PATRONUS PHYSICIANS GROUP PC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 8000 TOWERS CRESCENT DR SUITE 1350
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City | VIENNA
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State | VA
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Zip | 22182-6207
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Country | US
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Telephone | 866-450-1918
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Fax |
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Provider Business Mailing Address
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Address Line | 8000 TOWERS CRESCENT DR SUITE 1350
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City | VIENNA
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State | VA
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Zip | 22182-6207
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Country | US
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Telephone | 866-450-1918
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CAREY GRAINGER
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Credential |
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Telephone | 404-822-4823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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