MEDICARE: DR. MARTHA A. GRISWOLD 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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	0101033077	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	:	1306802426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA A. GRISWOLD M.D.

Provider Business Mailing Address
First Line	:	430 CLAREMONT CT
Second Line	:	SUITE 212
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1770
Country	:	US
Telephone Number	:	804-520-0892
Fax Number	:	804-520-0896

Provider Business Practice Location Address
First Line	:	173 WATERFRONT DR
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2181
Country	:	US
Telephone Number	:	804-520-5165
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/08/2026

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