Individual
DR. THOMAS RUSSELL GRANT
Active
Individual
DR. THOMAS RUSSELL GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101036347
VA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
0101036347
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-002 -003
TRICARE/CHAMPUS
VA
05
—
005612632
—
VA
05
—
005624151
—
VA
01
—
0526K
BC/BS
NC
01
—
081925
ANTHEM
VA
01
—
11025
SENTARA OPTIMA
VA
01
—
2180424
UHC/MAMSI
VA
05
—
890526K
—
NC
01
—
PAR
VIRGINIA PREMIER HEALTH
VA
Enumeration date
02/16/2006
Last updated
01/23/2009
Update your record
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