Provider Demographics
NPI:1962400267
Name:GROENING, DAVID A (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GROENING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CREST RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-9753
Mailing Address - Country:US
Mailing Address - Phone:802-524-8985
Mailing Address - Fax:802-527-0977
Practice Address - Street 1:3 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9753
Practice Address - Country:US
Practice Address - Phone:802-524-8985
Practice Address - Fax:802-527-0977
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT056-0000124213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009242Medicaid
VT54V001OtherMOHAWK VALLEY PLAN
VT8318OtherBCBS
VT480006391OtherRAILROAD MEDICARE/UHC
VT8318OtherBCBS
VTVT9242Medicare PIN