Provider Demographics
NPI:1932108180
Name:GROTEN, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:GROTEN
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 1559
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1559
Mailing Address - Country:US
Mailing Address - Phone:304-487-1076
Mailing Address - Fax:304-425-9499
Practice Address - Street 1:608 NEW HOPE RD STE 7
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2287
Practice Address - Country:US
Practice Address - Phone:304-487-1076
Practice Address - Fax:304-425-9499
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV198392085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7200503000Medicaid
WV7200503000Medicaid
GR0893901Medicare ID - Type Unspecified