Individual
DANIEL GROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1114 MOORMAN AVE NW, ROANOKE, VA 24017-5738
(540) 556-1178
Mailing address
1114 MOORMAN AVE NW, ROANOKE, VA 24017-5738
(540) 556-1178
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2705100660
VA
Other
Enumeration date
07/14/2026
Last updated
07/14/2026
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