Provider Demographics
NPI:1093903551
Name:RICHARD A GRUEN MD PA
Entity Type:Organization
Organization Name:RICHARD A GRUEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GRUEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-654-5700
Mailing Address - Street 1:10 CROSSROADS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5458
Mailing Address - Country:US
Mailing Address - Phone:410-654-5700
Mailing Address - Fax:410-654-5399
Practice Address - Street 1:10 CROSSROADS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5458
Practice Address - Country:US
Practice Address - Phone:410-654-5700
Practice Address - Fax:410-654-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025907207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK991Medicare PIN