Healthcare Provider Details

I. General information

NPI: 1821055930
Provider Name (Legal Business Name): ROGER L GROVES, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W LANCASTER AVE SUITE 215
PAOLI PA
19301-1751
US

IV. Provider business mailing address

250 W LANCASTER AVE SUITE 215
PAOLI PA
19301-1751
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-1204
  • Fax: 610-647-1240
Mailing address:
  • Phone: 610-647-1204
  • Fax: 610-647-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD033248L
License Number StatePA

VIII. Authorized Official

Name: DR. ROGER L GROVES
Title or Position: PRESIDENT
Credential: MD
Phone: 610-647-1204