Provider Demographics
NPI:1740254309
Name:GROB, DANIEL KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KENNETH
Last Name:GROB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8150 PERRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5200
Mailing Address - Country:US
Mailing Address - Phone:412-369-9550
Mailing Address - Fax:412-369-9566
Practice Address - Street 1:1140 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2160
Practice Address - Country:US
Practice Address - Phone:412-364-4402
Practice Address - Fax:412-364-3850
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD062997L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001729440-0005Medicaid
PA001729440-0004Medicaid