Provider Demographics
NPI:1588298418
Name:GRUNWALDT FALBO PLLC
Entity type:Organization
Organization Name:GRUNWALDT FALBO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORELEI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNWALDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-582-9990
Mailing Address - Street 1:873 BEBOUT RD
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1215
Mailing Address - Country:US
Mailing Address - Phone:724-518-9897
Mailing Address - Fax:
Practice Address - Street 1:873 BEBOUT RD
Practice Address - Street 2:
Practice Address - City:VENETIA
Practice Address - State:PA
Practice Address - Zip Code:15367-1215
Practice Address - Country:US
Practice Address - Phone:724-518-9897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002037589OtherHIGHMARK BLUE SHIELD