Healthcare Provider Details

I. General information

NPI: 1902884950
Provider Name (Legal Business Name): GERALD E GRONBORG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 PEACH ORCHARD RD
MC CONNELLSBURG PA
17233-8559
US

IV. Provider business mailing address

214 PEACH ORCHARD RD
MC CONNELLSBURG PA
17233-8559
US

V. Phone/Fax

Practice location:
  • Phone: 717-485-3155
  • Fax: 717-485-6105
Mailing address:
  • Phone: 717-485-3155
  • Fax: 717-485-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003442L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC003442L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberSC003442L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC003442L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: