Provider Demographics
NPI:1316211774
Name:GROH, TERESA (PA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GROH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5964 GOLF CLUB LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8224
Mailing Address - Country:US
Mailing Address - Phone:513-893-1100
Mailing Address - Fax:
Practice Address - Street 1:5964 GOLF CLUB LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8224
Practice Address - Country:US
Practice Address - Phone:513-893-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0130766Medicaid