Provider Demographics
NPI:1801876677
Name:GRIMSON, JAMES MCCALL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MCCALL
Last Name:GRIMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:P O BOX 12087
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23612-2087
Mailing Address - Country:US
Mailing Address - Phone:757-867-6102
Mailing Address - Fax:757-867-6587
Practice Address - Street 1:500 J. CLYDE MORRIS BLVD
Practice Address - Street 2:RIVERSIDE REGIONAL MEDICAL CENTER
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-4405
Practice Address - Fax:757-867-6587
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012395012085R0202X
NC1424282085R0202X
CAAFE733542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00980543OtherRAILROAD MEDICARE
VAP00980543OtherRAILROAD MEDICARE
VAVV1979AMedicare PIN