Provider Demographics
NPI:1003885708
Name:GRUBE, HEINRICH HM (MD)
Entity Type:Individual
Prefix:
First Name:HEINRICH
Middle Name:HM
Last Name:GRUBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:35 MEDICAL CENTER PARKWAY, SUITE 101
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-430-4321
Practice Address - Fax:207-430-4320
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD15990207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME283940099Medicaid
NH30207223Medicaid
043861OtherANTHEM
3064022OtherAETNA
MEMM957004Medicare PIN
MEME0277Medicare PIN
MEMM9570Medicare PIN
3064022OtherAETNA
NH30207223Medicaid
043861OtherANTHEM
MEG86356Medicare UPIN
ME283940099Medicaid