MEDICARE: DR. DARLENE Y. GRUETTER MD

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	174400000X	Specialist	16894	WV
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	16894	WV

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205839800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARLENE Y. GRUETTER MD

Provider Business Mailing Address
First Line	:	1400 HOSPITAL DR
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9202
Country	:	US
Telephone Number	:	304-757-1770
Fax Number	:	304-757-1736

Provider Business Practice Location Address
First Line	:	3200 MACCORKLE AVENUE SE
Second Line	:	PATHOLOGY DEPARTMENT
City	:	CHARLESTON
State	:	WV
Zip	:	25304
Country	:	US
Telephone Number	:	304-388-5550
Fax Number	:	304-388-4352

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/23/2015

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