Provider Demographics
NPI:1427055755
Name:GROB, ROBERT B (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:GROB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1310
Mailing Address - Country:US
Mailing Address - Phone:610-377-2224
Mailing Address - Fax:610-377-6484
Practice Address - Street 1:246 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1310
Practice Address - Country:US
Practice Address - Phone:610-377-2224
Practice Address - Fax:610-377-6484
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009351L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017994810001Medicaid
H12285Medicare UPIN
036419KKLMedicare ID - Type Unspecified