MEDICARE: DR. KATHRYN EILEEN 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	208100000X	Physical Medicine & Rehabilitation Physician	0101033453	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

General Provider Information

NPI Number	:	1861489866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN EILEEN GRANT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1400
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22038-1400
Country	:	US
Telephone Number	:	703-383-9543
Fax Number	:	703-383-9532

Provider Business Practice Location Address
First Line	:	1701 N GEORGE MASON DR
Second Line	:	C/O VIRGINIA HOSPITAL CENTER - PM&R DEPT
City	:	ARLINGTON
State	:	VA
Zip	:	22205-3610
Country	:	US
Telephone Number	:	703-558-6507
Fax Number	:	703-558-5715

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/09/2007

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