Provider Demographics
NPI:1447250469
Name:GRONDZIOWSKI, PETER MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:GRONDZIOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MCLAUGHLIN RUN RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-3100
Mailing Address - Country:US
Mailing Address - Phone:412-319-7215
Mailing Address - Fax:412-319-7041
Practice Address - Street 1:1580 MCLAUGHLIN RUN RD
Practice Address - Street 2:SUITE 212
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-3100
Practice Address - Country:US
Practice Address - Phone:412-319-7215
Practice Address - Fax:412-319-7041
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044862L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2005524-000Medicaid
PA0017395540012Medicaid
OH2371071Medicaid
PA0017395540012Medicaid
PA460003627Medicare PIN
PA610274Q17Medicare PIN
PA460003626Medicare PIN
WV2005524-000Medicaid