Healthcare Provider Details

I. General information

NPI: 1003926148
Provider Name (Legal Business Name): THE PRACTICE OF PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 SCOTLAND AVE
CHAMBERSBURG PA
17201-1450
US

IV. Provider business mailing address

1942 SCOTLAND AVE
CHAMBERSBURG PA
17201-1450
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-2930
  • Fax: 717-263-9556
Mailing address:
  • Phone: 717-263-2930
  • Fax: 717-263-9556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD035111E
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL FRANKLIN GROSSBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 717-263-2930