1578546024 NPI number — DR. BRUCE H. GROSSINGER DO

Table of content: (NPI 1083906937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578546024 NPI number — DR. BRUCE H. GROSSINGER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSSINGER
Provider First Name:
BRUCE
Provider Middle Name:
H.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578546024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 CHESTER PIKE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
EDDYSTONE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19022-1375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-521-6063
Provider Business Practice Location Address Fax Number:
610-521-0163
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  OS005992L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: C20004994 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: OS005992L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: OS005992L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: C20004994 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: C20004994 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000035987 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1280858 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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