Provider Demographics
NPI:1730103342
Name:GROH, KENNETH J (PA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:GROH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8322 BELLONA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2012
Mailing Address - Country:US
Mailing Address - Phone:410-337-7900
Mailing Address - Fax:410-337-5321
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2012
Practice Address - Country:US
Practice Address - Phone:410-337-7900
Practice Address - Fax:410-337-5321
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0000778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant