Provider Demographics
NPI:1225075625
Name:GRUENTHER, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:GRUENTHER
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 1:947 E JOHNSTOWN RD
Mailing Address - Street 2:#160
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1851
Mailing Address - Country:US
Mailing Address - Phone:614-636-0553
Mailing Address - Fax:
Practice Address - Street 1:3813 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9330
Practice Address - Country:US
Practice Address - Phone:614-835-0400
Practice Address - Fax:614-835-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-8309-G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0742316Medicaid
C61948Medicare UPIN
4039372Medicare PIN