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NPI Code Detail

MEDICARE: PHILLIP D GRANGER PA-C

MEDICARE: PHILLIP D GRANGER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0110001146VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00406238OTHERVARAILROAD MEDICARE

General Provider Information

NPI Number : 1003862939
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP D GRANGER PA-C
Provider Business Mailing Address
First Line : 5000 COX RD
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9263
Country : US
Telephone Number : 804-968-5700
Fax Number :
Provider Business Practice Location Address
First Line : 3432 HOLLAND RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-4846
Country : US
Telephone Number : 757-468-1855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 06/23/2021

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Directions to “ PHILLIP D GRANGER PA-C” Practice Location

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