MEDICARE: DR. TAD EDWARD GRENGA 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	208200000X	Plastic Surgery Physician	0101041085	VA

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	118152	OTHER	VA	ANTHEM
3	410829	OTHER	VA	MAMSI
4	15906	OTHER	VA	SENTARA/OPTIMA

General Provider Information

NPI Number	:	1124009253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAD EDWARD GRENGA MD

Provider Business Mailing Address
First Line	:	5818 HARBOUR VIEW BLVD
Second Line	:	SUITE 220
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3315
Country	:	US
Telephone Number	:	757-673-5900
Fax Number	:	757-673-5905

Provider Business Practice Location Address
First Line	:	5818 HARBOUR VIEW BLVD
Second Line	:	SUITE 220
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3315
Country	:	US
Telephone Number	:	757-673-5900
Fax Number	:	757-673-5905

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	01/06/2017

Similar Medicare Providers

1891791687 — CECELIA M SCOTECE PA
Practice Location Address:

5818 HARBOUR VIEW BLVD , SUITE 230
SUFFOLK, VA
23435-3315

Practice Phone: 757-686-1042
Practice Fax: 757-686-1055

1225010143 — PIERRE THOMAS MARTIN MD
Practice Location Address:

5818 HARBOUR VIEW BLVD , SUITE 230
SUFFOLK, VA
23435-3315

Practice Phone: 757-673-6118
Practice Fax: 757-967-9003

1831173665 — DR. ANANT S DAMLE MD
Practice Location Address:

5818 HARBOUR VIEW BLVD , STE 240
SUFFOLK, VA
23435-3315

Practice Phone: 757-483-6100
Practice Fax: 757-483-2203

1154305795 — MRS. KATHRYN A POND FNP
Practice Location Address:

5818 HARBOUR VIEW BLVD , STE 240
SUFFOLK, VA
23435-3315

Practice Phone: 757-483-6100
Practice Fax: 757-673-5950

1356383558 — CHERYL ANN WRAY MA
Practice Location Address:

5818 HARBOUR VIEW BLVD STE 230D
SUFFOLK, VA
23435-3315

Practice Phone: 757-673-6118
Practice Fax: 757-967-9003

1669418174 — TRACY L KNAAK PA-C
Practice Location Address:

5818 HARBOUR VIEW BLVD STE 240
SUFFOLK, VA
23435-3315

Practice Phone: 757-397-2383
Practice Fax: 757-673-0236

Directions to “ DR. TAD EDWARD GRENGA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.