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NPI Code Detail

MEDICARE: PATRONUS PHYSICIANS GROUP PC

MEDICARE: PATRONUS PHYSICIANS GROUP PC
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
12084V0102XVascular Neurology Physician
2208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1851830178
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATRONUS PHYSICIANS GROUP PC
Provider Business Mailing Address
First Line : 8000 TOWERS CRESCENT DR
Second Line : SUITE 1350
City : VIENNA
State : VA
Zip : 22182-6207
Country : US
Telephone Number : 866-450-1918
Fax Number :
Provider Business Practice Location Address
First Line : 8000 TOWERS CRESCENT DR
Second Line : SUITE 1350
City : VIENNA
State : VA
Zip : 22182-6207
Country : US
Telephone Number : 866-450-1918
Fax Number :
Authorized Official
Title or Position : CEO
Name : CAREY GRAINGER
Credential :
Telephone Number : 404-822-4823
Provider Enumeration Date : 02/20/2017
Last Update Date : 02/20/2017

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Directions to “PATRONUS PHYSICIANS GROUP PC ” Practice Location

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