Healthcare Provider Details

I. General information

NPI: 1295706331
Provider Name (Legal Business Name): HAROLD LAWRENCE GROFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NEW MEXICO MEDICAL CENTER MSC11 6093
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

MSC CRITICAL CARE MEDICINE 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-0148
  • Fax: 505-272-9991
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101230961
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberRS2019-0419
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: