Provider Demographics
NPI:1083629935
Name:CHARLES E. GRONCY, MD INC
Entity Type:Organization
Organization Name:CHARLES E. GRONCY, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRONCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-680-6220
Mailing Address - Street 1:301 W BASTANCHURY RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3419
Mailing Address - Country:US
Mailing Address - Phone:714-680-6220
Mailing Address - Fax:714-680-3893
Practice Address - Street 1:301 W BASTANCHURY RD
Practice Address - Street 2:SUITE 25
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3419
Practice Address - Country:US
Practice Address - Phone:714-680-6220
Practice Address - Fax:714-680-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36424207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA030002866Medicare ID - Type UnspecifiedRAILROAD
CAC36424AMedicare PIN
CAA36261Medicare UPIN