Provider Demographics
NPI:1639251150
Name:GROEBER, SANDRA JOY (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOY
Last Name:GROEBER
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 1:823 S KING ST
Mailing Address - Street 2:F
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3915
Mailing Address - Country:US
Mailing Address - Phone:703-777-5222
Mailing Address - Fax:703-777-5144
Practice Address - Street 1:823 S KING ST
Practice Address - Street 2:F
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3915
Practice Address - Country:US
Practice Address - Phone:703-777-5222
Practice Address - Fax:703-777-5144
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01876Medicare UPIN