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NPI Code Detail

MEDICARE: MICHAEL B DEGRANDPRE PA

MEDICARE: MICHAEL B DEGRANDPRE PA
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
1363A00000XPhysician Assistant0010-15582NC
2363A00000XPhysician Assistant0110001114VA

General Provider Information

NPI Number : 1366486060
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL B DEGRANDPRE PA
Provider Business Mailing Address
First Line : PO BOX 3648
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23187-3648
Country : US
Telephone Number : 757-221-7111
Fax Number : 757-221-8085
Provider Business Practice Location Address
First Line : 8260 ATLEE RD
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23116-1844
Country : US
Telephone Number : 804-764-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 02/02/2026

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