Provider Demographics
NPI:1780644831
Name:GRUBB, CHARLES R (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:GRUBB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:311 BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1841
Mailing Address - Country:US
Mailing Address - Phone:908-454-8787
Mailing Address - Fax:908-454-1192
Practice Address - Street 1:3794 HECKTOWN RD STE 250
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2355
Practice Address - Country:US
Practice Address - Phone:484-544-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB03357700207Q00000X
PAOS003693L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051817OtherHORIZON BC/BS
NJ2118788002OtherAMERIHEALTH
NJ2K2095OtherACS/HEALTHNET
NJ530507OtherAETNA
NJ223713972OtherUNITED HEALTHCARE
NJP591243OtherOXFORD
NJ2118788002OtherKEYSTONE
NJ2862905Medicaid
NJ223713972OtherCIGNA HEALTHCARE
NJ530507OtherAETNA
PA807977Q3VMedicare PIN