MEDICARE: DR. GEORGE IRA GRAYSON M.D.

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	207RP1001X	Pulmonary Disease Physician	0101031724	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

General Provider Information

NPI Number	:	1285621060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE IRA GRAYSON M.D.

Provider Business Mailing Address
First Line	:	816 INDEPENDENCE BLVD
Second Line	:	SUITE 3K
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6010
Country	:	US
Telephone Number	:	757-460-9200
Fax Number	:	757-460-6553

Provider Business Practice Location Address
First Line	:	816 INDEPENDENCE BLVD
Second Line	:	SUITE 3K
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6010
Country	:	US
Telephone Number	:	757-460-9200
Fax Number	:	757-460-6553

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	11/04/2009

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