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General NPI Number Information
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NPI Number | 1063484442
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Entity Type | Individual
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Provider Name | MARC DAVID GROBMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 3411 SILVERSIDE RD WELDIN BUILDING SUITE 102
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City | WILMINGTON
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State | DE
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Zip | 19810-4812
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Country | US
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Telephone | 302-479-0580
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Fax | 302-479-0583
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Provider Business Mailing Address
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Address Line | 1602 NEWPORT GAP PIKE
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City | WILMINGTON
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State | DE
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Zip | 19808-6208
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Country | US
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Telephone | 302-633-5840
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Fax | 302-633-5844
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C2-0003657
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License Number State | DE
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