Basic Information
Provider Information
NPI: 1073533477
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GROH
FirstName: CHRISTOPHER
MiddleName: P.
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1701 WESTCHESTER DRIVE
Address2: SUITE 850
City: HIGH POINT
State: NC
PostalCode: 272627254
CountryCode: US
TelephoneNumber: 3368022400
FaxNumber: 3368022001
Practice Location
Address1: 624 QUAKER LN
Address2: SUITE 105C
City: HIGH POINT
State: NC
PostalCode: 272623832
CountryCode: US
TelephoneNumber: 3368022105
FaxNumber: 3368022106
Other Information
ProviderEnumerationDate: 07/20/2006
LastUpdateDate: 06/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0010-00113NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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