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NPI Code Detail

MEDICARE: DR. MARTIN A GROSS M.D.

MEDICARE: DR. MARTIN A GROSS M.D.
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
1208000000XPediatrics Physician52598MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386629103
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARTIN A GROSS M.D.
Provider Business Mailing Address
First Line : 2 LAKEVILLE BUSINESS PARK
Second Line :
City : LAKEVILLE
State : MA
Zip : 02347-1236
Country : US
Telephone Number : 508-947-0630
Fax Number :
Provider Business Practice Location Address
First Line : 2 LAKEVILLE BUSINESS PARK
Second Line :
City : LAKEVILLE
State : MA
Zip : 02347-1236
Country : US
Telephone Number : 508-947-0630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 07/08/2007

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