Provider Demographics
NPI:1720081151
Name:GRUBBS, ANDREW D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:GRUBBS
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 632778
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2778
Mailing Address - Country:US
Mailing Address - Phone:513-891-7574
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:4015 EXECUTIVE PARK DR
Practice Address - Street 2:STE 406
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4017
Practice Address - Country:US
Practice Address - Phone:513-569-6747
Practice Address - Fax:513-563-6988
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-049478207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0617916Medicaid
OHP00314600OtherRAILROAD MEDICARE
OH0617916Medicaid
OHP00314600OtherRAILROAD MEDICARE