Individual
LEROY T. GRAVATTE IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4916 PLANK RD, NORTH GARDEN, VA 22959-1613
(434) 243-4660
(434) 244-9476
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101042101
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10035490
—
VA
Enumeration date
05/08/2006
Last updated
06/30/2023
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