Individual
MICHAEL GRILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20486 MARKET STREET, ONANCOCK, VA 23417
(757) 302-2700
(757) 787-9262
Mailing address
8262 ATLEE RD, SUITE 205, MECHANICSVILLE, VA 23116-1816
(804) 559-0194
(804) 559-0198
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101055534
VA
208600000X
Surgery Physician
0101055534
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020002600
BLACK LUNG
VA
01
—
1073988
BRICKSTREET-WV COMP
WV
01
—
1373138
CIGNA
VA
05
—
1639178122
—
VA
01
—
178223
BCBS
VA
01
—
2132448
MAMSI
VA
05
—
3810012912
—
WV
01
—
5472512
AETNA
VA
05
—
790577T
—
NC
01
—
C06115
GROUP PTAN
VA
Enumeration date
07/18/2005
Last updated
11/11/2019
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