MEDICARE: MARC DAVID GROBMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C2-0003657	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	510334650	OTHER	DE	BCBS OF DE
3	08D0876971	OTHER	DE	CLIA
4	110044275	OTHER	DE	RRM

General Provider Information

NPI Number	:	1063484442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC DAVID GROBMAN D.O.

Provider Business Mailing Address
First Line	:	1602 NEWPORT GAP PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-6208
Country	:	US
Telephone Number	:	302-633-5840
Fax Number	:	302-633-5844

Provider Business Practice Location Address
First Line	:	3411 SILVERSIDE RD
Second Line	:	WELDIN BUILDING SUITE 102
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4812
Country	:	US
Telephone Number	:	302-479-0580
Fax Number	:	302-479-0583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	12/19/2011

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