Healthcare Provider Details

I. General information

NPI: 1760470959
Provider Name (Legal Business Name): CHAD AARON GROTEGUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-4597
US

IV. Provider business mailing address

DUMC BOX 3967
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax:
Mailing address:
  • Phone: 919-681-5220
  • Fax: 919-681-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD421884
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number200001591
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: