Provider Demographics
NPI:1114914496
Name:GROCHMAL, JAY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
Last Name:GROCHMAL
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 1:405 FREDERICK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4645
Mailing Address - Country:US
Mailing Address - Phone:410-744-5310
Mailing Address - Fax:410-744-7924
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4645
Practice Address - Country:US
Practice Address - Phone:410-744-5310
Practice Address - Fax:410-744-7924
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD16000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD968611801Medicaid
MD968611801Medicaid