1730382854 NPI number — DEBORAH MISSAL GRORUD MD

Table of content: DEBORAH MISSAL GRORUD MD (NPI 1730382854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730382854 NPI number — DEBORAH MISSAL GRORUD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRORUD
Provider First Name:
DEBORAH
Provider Middle Name:
MISSAL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MISSAL
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
JANINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730382854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 G ST NW
Provider Second Line Business Mailing Address:
SUITE 200 EAST
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20001-4545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-660-0005
Provider Business Mailing Address Fax Number:
202-660-0025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 G ST NW
Provider Second Line Business Practice Location Address:
SUITE 200 EAST
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20001-4545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-660-0005
Provider Business Practice Location Address Fax Number:
202-660-0025
Provider Enumeration Date:
06/06/2007

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: 207Q00000X , with the licence number:  MD037735 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 263043 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 231561 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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