Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36-00-3293 | OH |
Y | 222Z00000X | Podiatrist | 36-00-3293 | OH |
N | 213E00000X | Podiatrist | SC-00-5803 | PA |
N | 222Z00000X | Podiatrist | SC-00-5803 | PA |
NPI | 1073510301 |
---|---|
Provider Name | Thomas Groner |
First Address | Sandusky, OH 44871-0378 |
Second Address | Niles, OH 44446-3551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 21/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001627038 | HIGHMARK (01) | |
1010551400001 | (05) | PA |
1065838 | WORKERS COMP (01) | WV |
2478886 | (05) | OH |
3810000226 | (05) | WV |
7538513 | AETNA (01) |