Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 35-07-5897 | OH |
NPI | 1619997715 |
---|---|
Provider Name | Alexei A Grom |
First Address | Cincinnati, OH 45229-3039 |
Second Address | Cincinnati, OH 45229-3039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |