MEDICARE: JOHN D GRIMME 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	2085N0700X	Neuroradiology Physician	0101255768	VA
2	2085R0202X	Diagnostic Radiology Physician	25740	WV
3	2085R0202X	Diagnostic Radiology Physician	MD25664	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093751224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D GRIMME MD

Provider Business Mailing Address
First Line	:	8001 FORBES PL STE 103
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-2205
Country	:	US
Telephone Number	:	814-426-7319
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 PRINCE WILLIAM PKWY STE 302
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-7667
Country	:	US
Telephone Number	:	703-494-3309
Fax Number	:	703-321-3300

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	06/10/2022

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Directions to “ JOHN D GRIMME MD” Practice Location

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