MEDICARE: MONICA L GROSS MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD09154	RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	080164988	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040801208	OTHER		MRO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	152368	OTHER		TUFTS
4	01-01360	OTHER	RI	UNITED HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	400265	OTHER		BLUECHIP
8	1692	OTHER	RI	NHPRI
9	206343	OTHER	RI	BCBS

General Provider Information

NPI Number	:	1134129257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA L GROSS MD, MPH

Provider Business Mailing Address
First Line	:	360 KINGSTOWN RD
Second Line	:	SUITE 104
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-3239
Country	:	US
Telephone Number	:	401-789-1086
Fax Number	:	401-789-5344

Provider Business Practice Location Address
First Line	:	360 KINGSTOWN RD
Second Line	:	SUITE 104
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-3239
Country	:	US
Telephone Number	:	401-789-1086
Fax Number	:	401-789-5344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/27/2010

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