Provider Demographics
NPI:1306910310
Name:GROMAN & RUBIN DPM PA
Entity type:Organization
Organization Name:GROMAN & RUBIN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FARNWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-924-5044
Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 226
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1513
Mailing Address - Country:US
Mailing Address - Phone:301-924-5044
Mailing Address - Fax:301-924-5933
Practice Address - Street 1:344 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 110
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1948
Practice Address - Country:US
Practice Address - Phone:301-439-0300
Practice Address - Fax:301-681-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X261QA1903X
MDA1189261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD330682Medicare ID - Type UnspecifiedDC METRO