Provider Demographics
NPI:1801112479
Name:GRABILL, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GRABILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7113 THREE CHOPT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3643
Mailing Address - Country:US
Mailing Address - Phone:804-282-4205
Mailing Address - Fax:804-673-6432
Practice Address - Street 1:7113 THREE CHOPT RD STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-282-4205
Practice Address - Fax:804-324-6736
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101253282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty