Provider Demographics
NPI:1255572640
Name:NED M GROVE MD A PROFESSIONAL
Entity type:Organization
Organization Name:NED M GROVE MD A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NED
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-579-4459
Mailing Address - Street 1:50 S SAN MATEO DR STE 488
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3833
Mailing Address - Country:US
Mailing Address - Phone:650-579-4459
Mailing Address - Fax:650-342-0821
Practice Address - Street 1:50 S SAN MATEO DR STE 488
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3833
Practice Address - Country:US
Practice Address - Phone:650-579-4459
Practice Address - Fax:650-342-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22430Medicare UPIN