Provider Demographics
NPI:1730191172
Name:GROVER, ELEANOR V (PA-C)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:V
Last Name:GROVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 ACADEMY ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3178
Mailing Address - Country:US
Mailing Address - Phone:207-764-7200
Mailing Address - Fax:207-764-7201
Practice Address - Street 1:181 ACADEMY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3178
Practice Address - Country:US
Practice Address - Phone:207-764-7200
Practice Address - Fax:207-764-7201
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-131363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00206657OtherRR MEDICARE
MEAP0680Medicare PIN
MEP00206657OtherRR MEDICARE