MEDICARE: ELDESIA LABREN GRANGER MD

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
1	282N00000X	General Acute Care Hospital	D0075137	MD
2	2083P0901X	Public Health & General Preventive Medicine Physician	0101256984	VA
3	207R00000X	Internal Medicine Physician	0101256984	VA
4	208000000X	Pediatrics Physician	0101256984	VA

General Provider Information

NPI Number	:	1043471568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELDESIA LABREN GRANGER MD

Provider Business Mailing Address
First Line	:	2800 EISENHOWER AVE STE 220
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4587
Country	:	US
Telephone Number	:	703-424-9024
Fax Number	:	703-214-2955

Provider Business Practice Location Address
First Line	:	7918 JONES BRANCH DR FL 4
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3319
Country	:	US
Telephone Number	:	703-424-9024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	01/20/2026

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