Provider Demographics
NPI:1255308201
Name:GROMAN, GEORGE S (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:GROMAN
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 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2858
Mailing Address - Country:US
Mailing Address - Phone:410-997-7979
Mailing Address - Fax:410-997-9231
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2858
Practice Address - Country:US
Practice Address - Phone:410-997-7979
Practice Address - Fax:410-997-9231
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV879-0002OtherCAREFIRST GHMSI AND BLUE CHOICE
MD277511500Medicaid
MD0061936OtherAETNA
MD414605-05OtherCAREFIRST OF MARYLAND
MDP00908346OtherRAILROAD MEDICARE
MD0061936OtherAETNA
MD414605-05OtherCAREFIRST OF MARYLAND