Organization
WATERSHED UROLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE V. GRONKIEWICZ M.D. (PHYSICIAN)
(717) 241-2200
Entity
Organization
Contact information
Practice address
9 BROOKWOOD AVE, CARLISLE, PA 17015-9126
(717) 241-2200
(717) 245-9611
Mailing address
9 BROOKWOOD AVE, CARLISLE, PA 17015-9126
(717) 241-2200
(717) 245-9611
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD050185L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB4793
RAILROAD MEDICARE
PA
Enumeration date
03/21/2007
Last updated
01/15/2008
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