Provider Demographics
NPI:1639106859
Name:GRUMBERG, BEATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:
Last Name:GRUMBERG
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 1:8362 PINES BLVD STE 296
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6600
Mailing Address - Country:US
Mailing Address - Phone:954-318-6590
Mailing Address - Fax:954-318-6604
Practice Address - Street 1:3 SW 129TH AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1778
Practice Address - Country:US
Practice Address - Phone:954-433-4200
Practice Address - Fax:954-433-7710
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01644577Medicaid
FLU2138Medicare ID - Type Unspecified
FLG61493Medicare UPIN