MEDICARE: DR. MARY JO GROTE PHD

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	231H00000X	Audiologist	30001526	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5518-0001	OTHER	VA	CAREFIRST BCBS
2	0007472511	OTHER	VA	AETNA- PPO
3	265673	OTHER	VA	MAMSI, OPTIMUM, MDIPA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	265673	OTHER	VA	ALLIANCE
6	272803	OTHER	VA	BLUE CROSS BLUE SHIELD
7	54/1804291-001	OTHER	VA	CIGNA
8	541804291	OTHER	VA	PHCS
9	3311009	OTHER	VA	AETNA- HMO
10	541804291	OTHER	VA	GREAT WEST

General Provider Information

NPI Number	:	1427022045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JO GROTE PHD

Provider Business Mailing Address
First Line	:	PO BOX 68
Second Line	:
City	:	POLLOCKSVILLE
State	:	NC
Zip	:	28573-0068
Country	:	US
Telephone Number	:	252-635-3906
Fax Number	:	252-224-0378

Provider Business Practice Location Address
First Line	:	3110 WELLONS BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5247
Country	:	US
Telephone Number	:	252-638-2515
Fax Number	:	252-638-8538

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	09/20/2024

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Directions to “ DR. MARY JO GROTE PHD” Practice Location

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