Provider Demographics
NPI:1457355075
Name:GRANT, ILHAM CHERROUK (MD)
Entity type:Individual
Prefix:MRS
First Name:ILHAM
Middle Name:CHERROUK
Last Name:GRANT
Suffix:
Gender:F
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5168
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-932-4075
Practice Address - Fax:540-932-5199
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239858208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC132TUOtherBLUE CROSS/BLUE SHIELD
NC89132TUMedicaid
NC2008178Medicare ID - Type UnspecifiedPERFORMING PROVIDER #
NC89132TUMedicaid