Individual
PHILLIP D GRANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3432 HOLLAND RD, VIRGINIA BEACH, VA 23452-4846
(757) 468-1855
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001146
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00406238
RAILROAD MEDICARE
VA
Enumeration date
05/25/2006
Last updated
06/23/2021
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