MEDICARE: MARTHA GRAMLICH 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	207P00000X	Emergency Medicine Physician	0101030493	VA

General Provider Information

NPI Number	:	1255312583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA GRAMLICH MD

Provider Business Mailing Address
First Line	:	5210 BURKE DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-3309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 BURKE DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-3309
Country	:	US
Telephone Number	:	703-360-5216
Fax Number	:

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	04/21/2011

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