Provider Demographics
NPI:1821035304
Name:GROVES, SAMUEL S (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:GROVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1125
Mailing Address - Country:US
Mailing Address - Phone:304-343-9923
Mailing Address - Fax:304-343-9925
Practice Address - Street 1:2930 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1125
Practice Address - Country:US
Practice Address - Phone:304-343-9923
Practice Address - Fax:304-343-9925
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20327207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0011726000Medicaid
WV000465033OtherBCBS GROUP NUMBER
WV1327565OtherUMW GROUP NUMBER
WV1327565OtherUMW GROUP NUMBER
WV1327565OtherUMW GROUP NUMBER