Provider Demographics
NPI:1861545196
Name:GROFF, MARTIN GARY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GARY
Last Name:GROFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 N MERIDIAN ST STE 320
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1822
Mailing Address - Country:US
Mailing Address - Phone:317-844-7489
Mailing Address - Fax:317-581-1007
Practice Address - Street 1:9240 N MERIDIAN ST STE 320
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1822
Practice Address - Country:US
Practice Address - Phone:317-844-7489
Practice Address - Fax:317-581-1007
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010411A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7581142OtherAETNA
IN000000182487OtherBLUE CROSS
IN7581142OtherAETNA