Provider Demographics
NPI:1437253424
Name:GROHS, STEPHANIE JOAN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOAN
Last Name:GROHS
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 1:121 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2653
Mailing Address - Country:US
Mailing Address - Phone:207-721-8700
Mailing Address - Fax:207-729-0912
Practice Address - Street 1:121 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 2700
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-721-8700
Practice Address - Fax:207-721-8715
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013907207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102140000Medicaid
MEMD13907OtherLICENSE
10902681OtherCAQH
10902681OtherCAQH
MEMM5675Medicare PIN
ME102140000Medicaid