Provider Demographics
NPI:1982706685
Name:GRANT, WILLIAM P (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:GRANT
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:PO BOX 5447
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-0447
Mailing Address - Country:US
Mailing Address - Phone:757-497-7575
Mailing Address - Fax:
Practice Address - Street 1:760 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6206
Practice Address - Country:US
Practice Address - Phone:757-497-7575
Practice Address - Fax:757-490-1795
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000572213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9301658Medicaid
VAT21968Medicare UPIN
VA480000051Medicare PIN
VA0574290001Medicare NSC