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NPI Code Detail

MEDICARE: ANDREA L GROSVENOR PA

MEDICARE: ANDREA L GROSVENOR 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 Assistant0110002881VA

General Provider Information

NPI Number : 1528210218
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA L GROSVENOR PA
Provider Business Mailing Address
First Line : PO BOX 1460
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22402-1460
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 PARK HILL DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-3387
Country : US
Telephone Number : 540-631-7644
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2008
Last Update Date : 10/08/2010

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Directions to “ ANDREA L GROSVENOR PA” Practice Location

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