Provider Demographics
NPI:1811027626
Name:GRUBER, AMELIA B (MD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:B
Last Name:GRUBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMELIA
Other - Middle Name:B
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4480 CATLIN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2533
Mailing Address - Country:US
Mailing Address - Phone:216-481-2406
Mailing Address - Fax:
Practice Address - Street 1:4480 CATLIN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2533
Practice Address - Country:US
Practice Address - Phone:216-481-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 . 021848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0902698Medicaid