Gronborg, Gerald E

Gronborg, Gerald E is an individual health care provider with primary practice located at 2727 Beale Ave Suite A, Altoona PA 16601-1705. He recently has 4 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Radiology. Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine is his primary health care specialty. Gronborg, Gerald E can be contacted via phone (814) 946-1075.

Contact Information

Primary practice address
2727 Beale Ave Suite A Altoona PA 16601-1705
Phone: (814) 946-1075
Fax: (814) 946-4076
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine 213EP1101X SC003442L Pennsylvania
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X SC003442L Pennsylvania
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X SC003442L Pennsylvania
Podiatric Medicine & Surgery Service Providers / Radiology 213ER0200X SC003442L Pennsylvania

Profile Details

NPI number 1902884950
LBN Legal business name Gronborg, Gerald E
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2006
Last updated May 5th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902884950 NPPES
Pennsylvania MEDICAID 0012762560012
Pennsylvania Other 5166987
Pennsylvania Other 826758
Pennsylvania Other 000706203
Pennsylvania Other CC2226
Pennsylvania Other P 54229714
Pennsylvania MEDICAID 0012762560009
Pennsylvania MEDICAID 0012762560010
Pennsylvania Other 0857830000
Pennsylvania Other 200069
Pennsylvania Other 2805196
Pennsylvania Other 21128765012
Pennsylvania Other 480013965
Pennsylvania Other 1022107
Pennsylvania Other 7318023
Pennsylvania Other GR706203
Pennsylvania Other 000000060525

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