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Individual

MR. BERNARD DEAN GROSE II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
12 KANAWHA TER, SAINT ALBANS, WV 25177-2750
(304) 201-1130
(304) 201-1134
Mailing address
12 KANAWHA TER, SAINT ALBANS, WV 25177-2750
(304) 201-1130
(304) 201-1134

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01522
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1790087187
WV
05
3810019933
WV
01
WV1245B
MEDICARE PTAN
WV
01
WV1245C
MEDICARE PTAN
WV
Enumeration date
11/17/2010
Last updated
07/24/2023
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