Provider Demographics
NPI:1699841213
Name:GROUSE, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:GROUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WESTWOOD MEDICAL PARK
Mailing Address - Street 2:#13
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605
Mailing Address - Country:US
Mailing Address - Phone:276-322-5386
Mailing Address - Fax:276-322-2836
Practice Address - Street 1:19 WESTWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2003
Practice Address - Country:US
Practice Address - Phone:276-322-5386
Practice Address - Fax:276-322-2836
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1010374452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA087422OtherANTHEM BLUE CROSS
WV0091102000OtherWV MEDICAID
A72312Medicare UPIN
VA130000144Medicare ID - Type Unspecified