Provider Demographics
NPI:1326055104
Name:GROESBECK, MARCIE A (MD)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:A
Last Name:GROESBECK
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 1:50 N MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3702
Mailing Address - Country:US
Mailing Address - Phone:330-836-9721
Mailing Address - Fax:330-836-9627
Practice Address - Street 1:50 N MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3702
Practice Address - Country:US
Practice Address - Phone:330-836-9721
Practice Address - Fax:330-836-9627
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0535031Medicaid
OH000000140418OtherANTHEM
OH80132213OtherRAILROAD MEDICARE
OH0539165Medicare PIN
OH0535031Medicaid