Provider Demographics
NPI:1245302215
Name:GROHMAN, MARIE E (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:GROHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12239 SE 92ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2063
Mailing Address - Country:US
Mailing Address - Phone:425-454-8191
Mailing Address - Fax:425-454-3037
Practice Address - Street 1:1380 112TH AVE NE
Practice Address - Street 2:#100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3759
Practice Address - Country:US
Practice Address - Phone:425-454-8191
Practice Address - Fax:425-454-3037
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB07850Medicare ID - Type UnspecifiedWA MEDICARE NUMBER