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General NPI Number Information
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NPI Number | 1245302215
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Entity Type | Individual
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Provider Name | MARIE E. GROHMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1380 112TH AVE NE #100
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City | BELLEVUE
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State | WA
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Zip | 98004-3759
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Country | US
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Telephone | 425-454-8191
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Fax | 425-454-3037
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Provider Business Mailing Address
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Address Line | 12239 SE 92ND ST
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City | NEWCASTLE
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State | WA
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Zip | 98056-2063
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Country | US
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Telephone | 425-454-8191
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Fax | 425-454-3037
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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 | MD00035561
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License Number State | WA
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