Organization
MARTHA A. GRISWOLD MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA A. GRISWOLD M.D., P.C. (OWNER)
(804) 861-8444
Entity
Organization
Contact information
Practice address
507 S SYCAMORE ST, PETERSBURG, VA 23803-5037
(804) 861-8444
(804) 862-1582
Mailing address
507 S SYCAMORE ST, PETERSBURG, VA 23803-5037
(804) 861-8444
(804) 862-1582
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101033077
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006097812
—
VA
01
—
1770771248
NPI
—
01
—
C10320
MEDICARE GROUP
—
Enumeration date
10/10/2007
Last updated
01/07/2008
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