Provider Demographics
NPI:1376528182
Name:GROB, RENEE J (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:J
Last Name:GROB
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:125-1 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-674-2788
Mailing Address - Fax:302-678-1765
Practice Address - Street 1:125-1 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-674-2788
Practice Address - Fax:302-678-1765
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC100043912080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEF86406Medicare UPIN