Provider Demographics
NPI:1790891455
Name:GRODMAN, HOWARD M (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:M
Last Name:GRODMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:830 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3302
Mailing Address - Country:US
Mailing Address - Phone:304-388-1552
Mailing Address - Fax:304-388-1577
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3302
Practice Address - Country:US
Practice Address - Phone:304-388-1552
Practice Address - Fax:304-388-1577
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1716782080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY171678OtherMEDICAL