Provider Demographics
NPI:1881815389
Name:GROVE, PHILIP SUMNER (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:SUMNER
Last Name:GROVE
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:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0780
Mailing Address - Country:US
Mailing Address - Phone:304-293-5033
Mailing Address - Fax:304-293-6963
Practice Address - Street 1:300 S PRESTON STREET
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438
Practice Address - Country:US
Practice Address - Phone:304-293-7401
Practice Address - Fax:304-293-6963
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21973207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3810003249Medicaid
GR6033501Medicare ID - Type Unspecified
H91232Medicare UPIN