Provider Demographics
NPI:1093751224
Name:GRIMME, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:GRIMME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 FORBES PL STE 103
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2205
Mailing Address - Country:US
Mailing Address - Phone:814-426-7319
Mailing Address - Fax:
Practice Address - Street 1:4001 PRINCE WILLIAM PKWY STE 302
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7667
Practice Address - Country:US
Practice Address - Phone:703-494-3309
Practice Address - Fax:703-321-3300
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012557682085N0700X
WV257402085R0202X
ORMD256642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093751224Medicaid
WA8425142Medicaid
OR213369Medicaid
MD475804801Medicaid
AKMD1459RMedicaid
WV1093751224Medicaid
AKMD3449RMedicaid
ORP00231172Medicare PIN
OR131705Medicare PIN
AKMD1459RMedicaid
OR135702Medicare PIN