MEDICARE: ALAN SCOTT GROTH D.O.

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	207R00000X	Internal Medicine Physician	OS004223L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871595181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN SCOTT GROTH D.O.

Provider Business Mailing Address
First Line	:	450 PARK WAY
Second Line	:	SUITE 300
City	:	BROOMALL
State	:	PA
Zip	:	19008-4202
Country	:	US
Telephone Number	:	484-422-8080
Fax Number	:	484-422-8073

Provider Business Practice Location Address
First Line	:	708 LONG LN
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-5101
Country	:	US
Telephone Number	:	610-626-2964
Fax Number	:	610-623-6535

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/16/2010

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Directions to “ ALAN SCOTT GROTH D.O.” Practice Location

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