Provider Demographics
NPI:1285636035
Name:GROVER, EVANGELINE (MD)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:
Last Name:GROVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 COMMERCE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2405
Mailing Address - Country:US
Mailing Address - Phone:215-653-0600
Mailing Address - Fax:215-646-4422
Practice Address - Street 1:270 COMMERCE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2405
Practice Address - Country:US
Practice Address - Phone:215-653-0600
Practice Address - Fax:215-646-4422
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD060329-L2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD060329-LOtherMEDICAL LICENSE
PAMD060329-LOtherMEDICAL LICENSE
PAG57326Medicare UPIN