Tad Edward Grenga, MD

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

0101041085 Issued in VA

Practice address

5818 Harbour View Blvd
Suite 220
Suffolk, VA 23435-3315

Phone

(757) 673-5900

Fax

(757) 673-5905

NPI assigned

Nov 7, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1124009253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5818 HARBOUR VIEW BLVD",
            "address_2": "SUITE 220",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353315",
            "telephone_number": "757-673-5900",
            "fax_number": "757-673-5905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5818 HARBOUR VIEW BLVD",
            "address_2": "SUITE 220",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353315",
            "telephone_number": "757-673-5900",
            "fax_number": "757-673-5905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRENGA",
        "first_name": "TAD",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "VA",
            "license": "0101041085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006901395",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "118152",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "410829",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA/OPTIMA",
            "identifier": "15906",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kitisha Green
• Greenbrook TMS Suffolk LLC
• Kelly Greenholtz
• Caitlin Greer, AU.D
• Douglas Blair Gregory, MD
• Jillian Rose Grenier, ORT/L
• Elizabeth Griffin, RPH
• Jocelyn Aleece Griffin, COTA/L
• Grit & Grace Counseling and Consulting Inc
• Amanda Grocutt

• Plastic Surgery Physician in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Plastic Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.