MEDICARE: DR. WILLIAM T GRANT 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	174400000X	Specialist	0101036663	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	H0672	OTHER	VA	RR MEDICARE - GRP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3502513	OTHER	VA	CIGNA
2	146381	OTHER	VA	SOUTHERN HEALTH
4	284735	OTHER	VA	ANTHEM
5	367116	OTHER	VA	MAMSI
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	14105	OTHER	VA	OPTIMA HEALTH

General Provider Information

NPI Number	:	1760485981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM T GRANT M.D.

Provider Business Mailing Address
First Line	:	908 E JEFFERSON ST
Second Line	:	SUITE 101
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-5375
Country	:	US
Telephone Number	:	434-817-7200
Fax Number	:	434-817-7205

Provider Business Practice Location Address
First Line	:	908 E JEFFERSON ST
Second Line	:	SUITE 101
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-5375
Country	:	US
Telephone Number	:	434-817-7200
Fax Number	:	434-817-7205

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/28/2012

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