Provider Demographics
NPI:1922191394
Name:GRINKEWITZ, PETER ROSS (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROSS
Last Name:GRINKEWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2957 BRUCE STA
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4258
Mailing Address - Country:US
Mailing Address - Phone:757-483-0969
Mailing Address - Fax:
Practice Address - Street 1:3640 HIGH ST STE 1D
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:757-393-1074
Practice Address - Fax:757-397-3412
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000751213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009303405Medicaid
VAT72537Medicare UPIN
VA480000218Medicare PIN