Provider Demographics
NPI:1285994236
Name:GROAG, ANDREA DINA (CNM)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DINA
Last Name:GROAG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:DINA
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:1165 IMPERIAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6555
Practice Address - Country:US
Practice Address - Phone:310-665-9098
Practice Address - Fax:301-665-9096
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R200366367A00000X
MDR200366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD994LMedicare PIN
MD244570YYKMedicare PIN