Provider Demographics
NPI:1639336167
Name:GRUNDEN, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:GRUNDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-1628
Mailing Address - Country:US
Mailing Address - Phone:717-426-1131
Mailing Address - Fax:717-426-2068
Practice Address - Street 1:1159 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-1628
Practice Address - Country:US
Practice Address - Phone:717-426-1131
Practice Address - Fax:717-426-2068
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192783390200000X
PAMD441932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program