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Jefferson Stanley Griscavage, ATC

Specialist/Technologist, Athletic Trainer in Pittsburgh, PA. Individual provider (NPI-1).

NPI number1366969321
StatusActive
Last updated in NPPESJul 10, 2018

Details

NPI
1366969321
Entity type
Individual (NPI-1)
Name
Jefferson Stanley Griscavage
Credential
ATC
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 29, 2017
Last updated
Jul 10, 2018

Medicare and OIG

Medicare enrolled (PECOS)
Not in the Medicare enrollment file
Can order and refer
Not on the CMS order and referring list
OIG exclusion list
This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer2000032338–Yes

Practice location

3600 Forbes Ave
Pittsburgh, PA 15213

Phone 703-232-9666

Mailing address

10700 Hampton Rd
Fairfax Station, VA 22039-2745

Phone 703-250-1102

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

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