Individual
VICTORIA E GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8051 PROSPERITY WAY STE 100, RUTHER GLEN, VA 22546
(804) 448-0198
(804) 448-0598
Mailing address
PO BOX 419402, BOSTON, MA 02241-9402
(855) 290-1552
(336) 774-6872
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101053568
VA
207R00000X
Internal Medicine Physician
95-00597
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010339413
—
VA
01
—
021044C18
MEDICARE PTAN
VA
Enumeration date
04/18/2006
Last updated
08/28/2019
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