Individual
MARK JOHN GRUCHACZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Mailing address
2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9700258
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1031X
BCBS ID NUMBER
NC
05
—
891031X
—
NC
Enumeration date
08/30/2005
Last updated
02/25/2021
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