Provider Demographics
NPI:1770690893
Name:GROMAN, CECILIA ANTONIETTA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:ANTONIETTA
Last Name:GROMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CECILIA
Other - Middle Name:ANTONIETTA
Other - Last Name:GROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 PRUSHNOK DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2343
Mailing Address - Country:US
Mailing Address - Phone:814-938-3310
Mailing Address - Fax:814-938-6804
Practice Address - Street 1:200 PRUSHNOK DR
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2343
Practice Address - Country:US
Practice Address - Phone:814-938-3310
Practice Address - Fax:814-938-6804
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001522L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232648RN0Medicare PIN
PA107589Q4DMedicare PIN