Basic Information
| Provider Information | |||||||||
| NPI: | 1093774713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRISWELL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 PICCARD DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208504303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019217900 | ||||||||
| FaxNumber: | 3019217915 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 NORTH GEORGE MASON DRIVE | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035586167 | ||||||||
| FaxNumber: | 7035585355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0072 | 01 | CARE FIRST | OTHER | 0058070575 | 05 | VA | MEDICAID |