Provider Demographics
NPI:1922046010
Name:GRUMBINE, ROWENA T (MD)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:T
Last Name:GRUMBINE
Suffix:
Gender:F
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 185
Mailing Address - Street 2:
Mailing Address - City:POCONO PINES
Mailing Address - State:PA
Mailing Address - Zip Code:18350-0185
Mailing Address - Country:US
Mailing Address - Phone:814-941-0418
Mailing Address - Fax:
Practice Address - Street 1:200 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5726
Practice Address - Country:US
Practice Address - Phone:410-871-6864
Practice Address - Fax:410-871-6526
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043734A208000000X
PAMD055349L208000000X
MDD0087861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G26629Medicare UPIN