MEDICARE: JAMES FRANCIS 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	2084P0800X	Psychiatry Physician	0101022563	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	085364	OTHER	VA	OPTIMA
3	004945395	OTHER	VA	VIRGINIA PREMIER
4	258220	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1487737185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES FRANCIS GRISWOLD M.D.

Provider Business Mailing Address
First Line	:	1854 DUKE OF YORK QUAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1108
Country	:	US
Telephone Number	:	757-496-9311
Fax Number	:

Provider Business Practice Location Address
First Line	:	3143 MAGIC HOLLOW BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-3077
Country	:	US
Telephone Number	:	757-385-8222
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/09/2007

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