Provider Demographics
NPI:1316029564
Name:GRONICH, JOSEPH HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HOWARD
Last Name:GRONICH
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 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1332
Mailing Address - Country:US
Mailing Address - Phone:215-657-2012
Mailing Address - Fax:215-657-2018
Practice Address - Street 1:735 FITZWATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1332
Practice Address - Country:US
Practice Address - Phone:215-657-2012
Practice Address - Fax:215-657-2018
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047133L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012921330003Medicaid
PA1031419OtherKEYSTONE MERCY
PA0048674000OtherIBC
PA110124758OtherRAILROAD MEDICARE
PA4288615OtherAETNA
PA02334MD047133LOtherHEALTH PARTNERS
PA231952978OtherTAX ID
PA0129213301OtherAMERICHOICE
PA0721084OtherCIGNA
PA096083OtherHIGHMARK
PA110124758OtherRAILROAD MEDICARE
PA231952978OtherTAX ID