Provider Demographics
NPI:1285621060
Name:GRAYSON, GEORGE IRA (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:IRA
Last Name:GRAYSON
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 1:816 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 3K
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6010
Mailing Address - Country:US
Mailing Address - Phone:757-460-9200
Mailing Address - Fax:757-460-6553
Practice Address - Street 1:816 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 3K
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-460-9200
Practice Address - Fax:757-460-6553
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031724207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006099548Medicaid
VA006099548Medicaid
A42201Medicare UPIN