Provider Demographics
NPI:1922031004
Name:GROCH, NICHOLAS RICHARD (DO)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:RICHARD
Last Name:GROCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2507
Mailing Address - Country:US
Mailing Address - Phone:315-349-5511
Mailing Address - Fax:315-349-5921
Practice Address - Street 1:140 W 6TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2525
Practice Address - Country:US
Practice Address - Phone:315-349-5828
Practice Address - Fax:315-349-5829
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008803207Y00000X
OH34-008803207Y00000X
FLOS10415207YS0123X
NY270541207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000486232OtherANTHEM
OH7268808OtherAETNA
OH06184OtherPARAMOUNT
OH2669189Medicaid
OHP00358244OtherRRMC
OH06184OtherPARAMOUNT
OH$$$$$$$$$-0001OtherMMO
OHP00358244OtherRRMC
OH$$$$$$$$$-004OtherMMO
$$$$$$$$$-007OtherMMO
OH7268808OtherAETNA
OH4186141Medicare UPIN
OHGR4186141Medicare PIN
$$$$$$$$$-007OtherMMO
OH$$$$$$$$$OtherHNFS
OH2669189Medicaid