MEDICARE: NICHOLAS M GRUMBACH 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
1	207R00000X	Internal Medicine Physician	MD10410	RI
2	208000000X	Pediatrics Physician	MD10410	RI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932105780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS M GRUMBACH M.D.

Provider Business Mailing Address
First Line	:	400 BALD HILL RD
Second Line	:	SUITE 520
City	:	WARWICK
State	:	RI
Zip	:	02886-1617
Country	:	US
Telephone Number	:	401-793-8520
Fax Number	:	401-793-8527

Provider Business Practice Location Address
First Line	:	400 BALD HILL RD
Second Line	:	SUITE 520
City	:	WARWICK
State	:	RI
Zip	:	02886-1617
Country	:	US
Telephone Number	:	401-793-8520
Fax Number	:	401-793-8527

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/30/2015

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