Individual
AUDREY LOUISE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3636 HIGH ST, PORTSMOUTH, VA 23707-3236
(757) 398-2200
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
(865) 292-3000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101043829
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194765826
—
VA
01
—
139PJ
BLUE CROSS
NC
05
—
170709
—
SC
05
—
5900979
—
NC
05
—
64315286
—
KY
01
—
P00247878
RAILROAD MEDICARE
VA
01
—
P00328958
RAILROAD MEDICARE
NC
Enumeration date
06/08/2006
Last updated
11/07/2007
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