MEDICARE: LONDON GROGAN

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	246RP1900X	Phlebotomy Technician
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1871312058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONDON GROGAN

Provider Business Mailing Address
First Line	:	2014 CHAMPIONS GTWY NW STE 301
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-2605
Country	:	US
Telephone Number	:	234-364-6957
Fax Number	:

Provider Business Practice Location Address
First Line	:	2014 CHAMPIONS GTWY NW STE 301
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-2605
Country	:	US
Telephone Number	:	234-364-6957
Fax Number	:

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

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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Directions to “ LONDON GROGAN ” Practice Location

Language	Start Address	Practice Location

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