Healthcare Provider Details

I. General information

NPI: 1912873621
Provider Name (Legal Business Name): GROOVE MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 MILLER AVE
BERKELEY CA
94708-1755
US

IV. Provider business mailing address

1152 MILLER AVE
BERKELEY CA
94708-1755
US

V. Phone/Fax

Practice location:
  • Phone: 510-200-8182
  • Fax:
Mailing address:
  • Phone: 510-200-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK WEISS
Title or Position: OPERATIONS ADMINISTRATOR
Credential:
Phone: 510-200-8182