Provider Demographics
NPI:1881651677
Name:GRONINGER, JAMES HUNTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HUNTER
Last Name:GRONINGER
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 1:2900 TELESTAR CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1206
Mailing Address - Country:US
Mailing Address - Phone:703-396-6194
Mailing Address - Fax:
Practice Address - Street 1:2900 TELESTAR CT
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1206
Practice Address - Country:US
Practice Address - Phone:703-396-6194
Practice Address - Fax:703-779-1372
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101237346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10200989Medicaid
VAI30487Medicare UPIN
VA10200989Medicaid