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NPI Code Detail

MEDICARE: DR. PETER W GROENEVELD M.D.

MEDICARE: DR. PETER W GROENEVELD M.D.
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
1207R00000XInternal Medicine PhysicianMD422222PA

General Provider Information

NPI Number : 1578574901
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER W GROENEVELD M.D.
Provider Business Mailing Address
First Line : 1229 BLOCKLEY HALL
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-6021
Country : US
Telephone Number : 215-898-2569
Fax Number :
Provider Business Practice Location Address
First Line : 3900 WOODLAND AVE
Second Line : PHILADELPHIA VA MEDICAL CENTER
City : PHILADELPHIA
State : PA
Zip : 19104-4551
Country : US
Telephone Number : 215-823-5800
Fax Number : 215-823-4411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/08/2007

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