Individual
MICHAEL H GRODIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1209 YORK RD, SUITE 200, LUTHERVILLE, MD 21093-6220
(410) 821-9490
(410) 821-9495
Mailing address
1209 YORK RD, SUITE 200, LUTHERVILLE, MD 21093-6220
(410) 821-9490
(410) 821-9495
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
0102201638
VA
207W00000X
Ophthalmology Physician
25MB08472300
NJ
207W00000X
Ophthalmology Physician
DO034176
DC
207W00000X
Ophthalmology Physician
Primary
H0062012
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143192VYZ
MEDICARE
MD
05
—
405458000
—
MD
Enumeration date
05/26/2006
Last updated
04/11/2012
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