MEDICARE: MICHAEL GRILLON MD

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	208600000X	Surgery Physician	0101055534	VA
2	207Q00000X	Family Medicine Physician	0101055534	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06115	OTHER	VA	GROUP PTAN
2	1073988	OTHER	WV	BRICKSTREET-WV COMP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	020002600	OTHER	VA	BLACK LUNG
5	2132448	OTHER	VA	MAMSI
6	5472512	OTHER	VA	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1373138	OTHER	VA	CIGNA
9	178223	OTHER	VA	BCBS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639178122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GRILLON MD

Provider Business Mailing Address
First Line	:	8262 ATLEE RD
Second Line	:	SUITE 205
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-1816
Country	:	US
Telephone Number	:	804-559-0194
Fax Number	:	804-559-0198

Provider Business Practice Location Address
First Line	:	20486 MARKET STREET
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417
Country	:	US
Telephone Number	:	757-302-2700
Fax Number	:	757-787-9262

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	11/11/2019

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Directions to “ MICHAEL GRILLON MD” Practice Location

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