Provider Demographics
NPI:1114985009
Name:GROOMES, RODERICK BERL (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:BERL
Last Name:GROOMES
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:PO BOX 760
Mailing Address - Street 2:EMERGENCY MEDICINE ASSOCIATES PC
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:ONE NOLTE DRIVE
Practice Address - Street 2:ARMSTRONG COUNTY MEMORIAL HOSPITAL
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201
Practice Address - Country:US
Practice Address - Phone:724-543-8109
Practice Address - Fax:724-543-8809
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034271E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001132588Medicaid
476140OtherHIGHMARK BS
C34531Medicare UPIN