Provider Demographics
NPI:1871595181
Name:GROTH, ALAN SCOTT (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:SCOTT
Last Name:GROTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:450 PARK WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-4202
Mailing Address - Country:US
Mailing Address - Phone:484-422-8080
Mailing Address - Fax:484-422-8073
Practice Address - Street 1:708 LONG LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5101
Practice Address - Country:US
Practice Address - Phone:610-626-2964
Practice Address - Fax:610-623-6535
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS004223L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009787190002Medicaid
PA190768K9LMedicare PIN
PA110090715Medicare PIN