MEDICARE: DR. NICHOLAS ROBERT GROSS DO

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	OS014865	PA

General Provider Information

NPI Number	:	1831353507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS ROBERT GROSS DO

Provider Business Mailing Address
First Line	:	518 PELLIS RD
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-4678
Country	:	US
Telephone Number	:	724-832-2570
Fax Number	:	724-832-2521

Provider Business Practice Location Address
First Line	:	518 PELLIS RD
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-4678
Country	:	US
Telephone Number	:	724-832-2570
Fax Number	:	724-832-2521

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

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	06/08/2011

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