Provider Demographics
NPI:1417925413
Name:VANGROUW, MICHAEL P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:VANGROUW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17241-1409
Mailing Address - Country:US
Mailing Address - Phone:717-776-3114
Mailing Address - Fax:717-776-5020
Practice Address - Street 1:100 S HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-1409
Practice Address - Country:US
Practice Address - Phone:717-776-3114
Practice Address - Fax:717-776-5020
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP49394Medicare UPIN