Grant, Thomas Russell

Grant, Thomas Russell is an individual health care provider with primary practice located at 825 Fairfax Ave , Norfolk VA 23507-1914. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Grant, Thomas Russell can be contacted via phone (757) 446-5955.

Contact Information

Primary practice address
825 Fairfax Ave Norfolk VA 23507-1914
Phone: (757) 446-5955
Fax: (757) 446-5196
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0101036347 Virginia
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 0101036347 Virginia

Profile Details

NPI number 1427022169
LBN Legal business name Grant, Thomas Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 16th, 2006
Last updated Jan 23rd, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427022169 NPPES
Virginia Other PAR VIRGINIA PREMIER HEALTH
Virginia MEDICAID 005612632 VIRGINIA PREMIER HEALTH
Virginia Other 0526K VIRGINIA PREMIER HEALTH
Virginia Other 081925 VIRGINIA PREMIER HEALTH
Virginia Other PAR VIRGINIA PREMIER HEALTH
Virginia Other 11025 VIRGINIA PREMIER HEALTH
Virginia MEDICAID 890526K VIRGINIA PREMIER HEALTH
Virginia Other PAR VIRGINIA PREMIER HEALTH
Virginia MEDICAID 005624151 VIRGINIA PREMIER HEALTH
Virginia Other PAR VIRGINIA PREMIER HEALTH
Virginia Other PAR VIRGINIA PREMIER HEALTH
Virginia Other -002 -003 VIRGINIA PREMIER HEALTH
Virginia Other 2180424 VIRGINIA PREMIER HEALTH
Virginia Other PAR VIRGINIA PREMIER HEALTH
Virginia Other PAR VIRGINIA PREMIER HEALTH
Virginia Other PAR VIRGINIA PREMIER HEALTH

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