MEDICARE: JOHN J MCGROARTY M D INC A MEDICAL CORPORATION

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	207W00000X	Ophthalmology Physician	G129381	CA

General Provider Information

NPI Number	:	1760514582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN J MCGROARTY M D INC A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	10614 RIVERSIDE DR.
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602
Country	:	US
Telephone Number	:	818-763-8839
Fax Number	:	818-769-7849

Provider Business Practice Location Address
First Line	:	10614 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2373
Country	:	US
Telephone Number	:	818-763-8839
Fax Number	:	818-769-7849

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. PATRICIA M BURNS
Credential	:
Telephone Number	:	818-763-8839

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	03/07/2012

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