Provider Demographics
NPI:1912122920
Name:GRUARIN, BEVERLY JEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JEAN
Last Name:GRUARIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2051
Mailing Address - Country:US
Mailing Address - Phone:412-681-8840
Mailing Address - Fax:412-681-9073
Practice Address - Street 1:4732 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2051
Practice Address - Country:US
Practice Address - Phone:412-681-8840
Practice Address - Fax:412-681-9073
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002856L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1054507Medicaid
T29852Medicare UPIN
PA166503Medicare PIN
PA1054507Medicaid