Provider Demographics
NPI:1457340986
Name:GROLMAN, RODNEY E (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:E
Last Name:GROLMAN
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 1:1550 S PIONEER WAY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4613
Mailing Address - Country:US
Mailing Address - Phone:410-218-8059
Mailing Address - Fax:
Practice Address - Street 1:1550 S PIONEER WAY
Practice Address - Street 2:SUITE 370
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4613
Practice Address - Country:US
Practice Address - Phone:410-218-8059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-08-06
Deactivation Date:2005-10-25
Deactivation Code:
Reactivation Date:2007-05-08
Provider Licenses
StateLicense IDTaxonomies
CAC53617208600000X
WAMD60050963208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1334455OtherAETNA HMO
MD402277700Medicaid
MD145724700OtherFEDERAL WORKMAN'S COMP
MD887BAA62011004OtherCAREFIRST
DCK5850005OtherCAREFIRST DC
MDP00354284OtherRR MEDICARE
MD7843490OtherAETNA PPO
MD689LO177Medicare PIN
DCK5850005OtherCAREFIRST DC