Provider Demographics
NPI:1730382854
Name:GRORUD, DEBORAH MISSAL (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MISSAL
Last Name:GRORUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JANINE
Other - Last Name:MISSAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 G ST NW
Mailing Address - Street 2:SUITE 200 EAST
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4545
Mailing Address - Country:US
Mailing Address - Phone:202-660-0005
Mailing Address - Fax:202-660-0025
Practice Address - Street 1:1001 G ST NW
Practice Address - Street 2:SUITE 200 EAST
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4545
Practice Address - Country:US
Practice Address - Phone:202-660-0005
Practice Address - Fax:202-660-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037735207Q00000X
NY263043207Q00000X
MA231561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC144157YT2Medicare PIN