Provider Demographics
NPI:1225224645
Name:JONATHAN M GROHSMAN MD
Entity type:Organization
Organization Name:JONATHAN M GROHSMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-576-5090
Mailing Address - Street 1:261 OLD YORK RD STE 520
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3721
Mailing Address - Country:US
Mailing Address - Phone:215-576-5090
Mailing Address - Fax:215-886-5480
Practice Address - Street 1:261 OLD YORK RD STE 520
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3721
Practice Address - Country:US
Practice Address - Phone:215-576-5090
Practice Address - Fax:215-886-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038112L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2314225000OtherBLUE CROSS