Provider Demographics
NPI:1821055930
Name:ROGER L GROVES, MD PC
Entity Type:Organization
Organization Name:ROGER L GROVES, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-647-1204
Mailing Address - Street 1:250 W LANCASTER AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1751
Mailing Address - Country:US
Mailing Address - Phone:610-647-1204
Mailing Address - Fax:610-647-1240
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1751
Practice Address - Country:US
Practice Address - Phone:610-647-1204
Practice Address - Fax:610-647-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033248L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0026452000OtherAMERIHEALTH
PA2454668001OtherKEYSTONE
PA4092568OtherAETNA
PA0010037310005Medicaid
PA30019442OtherKEYSTONE MERCY
PA122794OtherINDEP BLUE CROSS
PA255202OtherHEALTH AMERICA
PA0100373102OtherAMERICHOICE
PA0000104868802OtherUNITED HEALTHCARE
PA0875497OtherCIGNA
PA0875497OtherCIGNA
C30807Medicare UPIN
PA0010037310005Medicaid