Individual
DR. TAD EDWARD GRENGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5818 HARBOUR VIEW BLVD, SUITE 220, SUFFOLK, VA 23435-3315
(757) 673-5900
(757) 673-5905
Mailing address
5818 HARBOUR VIEW BLVD, SUITE 220, SUFFOLK, VA 23435-3315
(757) 673-5900
(757) 673-5905
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
0101041085
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006901395
—
VA
01
—
118152
ANTHEM
VA
01
—
15906
SENTARA/OPTIMA
VA
01
—
410829
MAMSI
VA
Enumeration date
11/07/2005
Last updated
01/06/2017
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