Provider Demographics
NPI:1902884950
Name:GRONBORG, GERALD E (DPM)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:GRONBORG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-8559
Mailing Address - Country:US
Mailing Address - Phone:717-485-3155
Mailing Address - Fax:717-485-8105
Practice Address - Street 1:214 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8559
Practice Address - Country:US
Practice Address - Phone:717-485-3155
Practice Address - Fax:717-485-6105
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003442L213ER0200X, 213E00000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0857830000OtherPPO PROGRAM INDEPENDENCE
PA5166987OtherPPNI
PA7318023OtherMAMSI
PA0012762560012Medicaid
PA000706203OtherKEYSTONE HEALTH PLAN
PA21128765012OtherBEECH STREET
PA0012762560010Medicaid
PA826758OtherBLUE SHIELD GROUP
PA2805196OtherAETNA HMO QPOS
PA480013965OtherRR MEDICARE INDIVIDUAL
PA1022107OtherGATEWAY
PA200069OtherUPMC
PACC2226OtherRR MEDICARE GROUP
PAP 54229714OtherMULTIPLAN
PA000000060525OtherUNISON
PAGR706203OtherBLUE SHIELD INDIVIDUAL
PA0012762560009Medicaid
PA0012762560010Medicaid
PAGR706203OtherBLUE SHIELD INDIVIDUAL
PA21128765012OtherBEECH STREET
PA2805196OtherAETNA HMO QPOS