Provider Demographics
NPI:1114908415
Name:GROCE, PHILIP CLARENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CLARENCE
Last Name:GROCE
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 1:321 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:ME
Mailing Address - Zip Code:04862-4824
Mailing Address - Country:US
Mailing Address - Phone:207-785-2969
Mailing Address - Fax:
Practice Address - Street 1:321 APPLETON RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:ME
Practice Address - Zip Code:04862-4824
Practice Address - Country:US
Practice Address - Phone:207-785-2969
Practice Address - Fax:207-785-2960
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD6797207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME008618OtherANTHEM
ME237410000Medicaid
011132479OtherRR MEDICARE
ME008618OtherANTHEM
ME05603001Medicare PIN
C66570Medicare UPIN