Provider Demographics
NPI:1376544056
Name:GROSCHAN, JAMES C (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:GROSCHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 W JOPPA RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4612
Mailing Address - Country:US
Mailing Address - Phone:410-938-8660
Mailing Address - Fax:410-938-8664
Practice Address - Street 1:2328 W JOPPA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4685
Practice Address - Country:US
Practice Address - Phone:410-938-8660
Practice Address - Fax:410-938-8664
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD35442407OtherBC RENDERING #
MD571153463OtherMD TAX ID #
MD571153463OtherMD TAX ID #
MDKEJ8OtherBC OF MD PROVIDER #