Provider Demographics
NPI:1073510301
Name:GRONER, THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GRONER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:720 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3551
Practice Address - Country:US
Practice Address - Phone:330-652-0535
Practice Address - Fax:330-652-0536
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-00-5803213E00000X
OH36-00-3293213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010551400001Medicaid
WV1065838OtherWORKERS COMP
7538513OtherAETNA
001627038OtherHIGHMARK
WV3810000226Medicaid
OH2478886Medicaid
4130903Medicare ID - Type Unspecified
4130899Medicare ID - Type Unspecified
PA083120P83Medicare PIN
4130901Medicare ID - Type Unspecified
4130896Medicare ID - Type Unspecified
4130902Medicare ID - Type Unspecified
4130891Medicare ID - Type Unspecified
4130892Medicare ID - Type Unspecified
4130897Medicare ID - Type Unspecified
OH2478886Medicaid
4130893Medicare ID - Type Unspecified
4130895Medicare ID - Type Unspecified
7538513OtherAETNA