Provider Demographics
NPI:1760877492
Name:GRUNER, MARC PHILIP (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:PHILIP
Last Name:GRUNER
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 1:10215 FERNWOOD RD STE 506
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1184
Mailing Address - Country:US
Mailing Address - Phone:301-350-1010
Mailing Address - Fax:
Practice Address - Street 1:8401 GREENSBORO DR STE 120
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-5101
Practice Address - Country:US
Practice Address - Phone:571-899-3590
Practice Address - Fax:571-378-1302
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN654242081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine