MEDICARE: DR. BRUCE H. GROSSINGER DO

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	2084N0400X	Neurology Physician	OS005992L	PA
2	2084N0400X	Neurology Physician	C20004994	DE
3	208VP0014X	Interventional Pain Medicine Physician	OS005992L	PA
4	208VP0000X	Pain Medicine Physician	OS005992L	PA
5	208VP0014X	Interventional Pain Medicine Physician	C20004994	DE
6	208VP0000X	Pain Medicine Physician	C20004994	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578546024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE H. GROSSINGER DO

Provider Business Mailing Address
First Line	:	1510 CHESTER PIKE
Second Line	:	SUITE 130
City	:	EDDYSTONE
State	:	PA
Zip	:	19022-1375
Country	:	US
Telephone Number	:	610-521-6063
Fax Number	:	610-521-0163

Provider Business Practice Location Address
First Line	:	1510 CHESTER PIKE
Second Line	:	SUITE 130
City	:	EDDYSTONE
State	:	PA
Zip	:	19022-1375
Country	:	US
Telephone Number	:	610-521-6063
Fax Number	:	610-521-0163

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	05/22/2014

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Directions to “ DR. BRUCE H. GROSSINGER DO” Practice Location

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