Provider Demographics
NPI:1063484442
Name:GROBMAN, MARC DAVID (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:DAVID
Last Name:GROBMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1602 NEWPORT GAP PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6208
Mailing Address - Country:US
Mailing Address - Phone:302-633-5840
Mailing Address - Fax:302-633-5844
Practice Address - Street 1:3411 SILVERSIDE RD
Practice Address - Street 2:WELDIN BUILDING SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4812
Practice Address - Country:US
Practice Address - Phone:302-479-0580
Practice Address - Fax:302-479-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0003657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000318803Medicaid
DE510334650OtherBCBS OF DE
DE08D0876971OtherCLIA
DE110044275OtherRRM
DE510334650OtherBCBS OF DE
DEE55684Medicare UPIN