Provider Demographics
NPI:1871312058
Name:GROGAN, LONDON
Entity type:Individual
Prefix:
First Name:LONDON
Middle Name:
Last Name:GROGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 CHAMPIONS GTWY NW STE 301
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2605
Mailing Address - Country:US
Mailing Address - Phone:234-364-6957
Mailing Address - Fax:
Practice Address - Street 1:2014 CHAMPIONS GTWY NW STE 301
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2605
Practice Address - Country:US
Practice Address - Phone:234-364-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy