MEDICARE: DR. KEVIN MICHAEL GROSZKOWSKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	0101236809	VA
2	208D00000X	General Practice Physician	D0066086	MD
3	207R00000X	Internal Medicine Physician	D0066086	MD

General Provider Information

NPI Number	:	1548240716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MICHAEL GROSZKOWSKI MD

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-897-9841
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 MITCHELLS CHANCE RD STE 180
Second Line	:
City	:	EDGEWATER
State	:	MD
Zip	:	21037-2793
Country	:	US
Telephone Number	:	410-224-8220
Fax Number	:	410-367-2118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2006
Last Update Date	:	06/02/2025

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