Basic Information
| Provider Information | |||||||||
| NPI: | 1972821593 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAMMES | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 844 KEMPSVILLE RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7572610701 | ||||||||
| Practice Location | |||||||||
| Address1: | 844 KEMPSVILLE RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7572610701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2010 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0102202645 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 0102202645 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | VAA103564 | 01 | INDIVIDUAL PTAN | OTHER |