Provider Demographics
NPI:1578546024
Name:GROSSINGER, BRUCE H (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:GROSSINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1510 CHESTER PIKE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1375
Mailing Address - Country:US
Mailing Address - Phone:610-521-6063
Mailing Address - Fax:610-521-0163
Practice Address - Street 1:1510 CHESTER PIKE
Practice Address - Street 2:SUITE 130
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1375
Practice Address - Country:US
Practice Address - Phone:610-521-6063
Practice Address - Fax:610-521-0163
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005992L2084N0400X, 208VP0014X, 208VP0000X
DEC200049942084N0400X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035987Medicaid
PA1280858Medicaid
E65396Medicare UPIN
DE1000035987Medicaid
PA1280858Medicaid
DEG02707G01Medicare PIN