Healthcare Provider Details

I. General information

NPI: 1245496090
Provider Name (Legal Business Name): SHELDON GROSS, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ALAMEDA DE LAS PULGAS SUITE 275
SAN MATEO CA
94403-1269
US

IV. Provider business mailing address

2000 ALAMEDA DE LAS PULGAS SUITE 275
SAN MATEO CA
94403-1269
US

V. Phone/Fax

Practice location:
  • Phone: 650-873-3444
  • Fax:
Mailing address:
  • Phone: 650-873-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG6607
License Number StateCA

VIII. Authorized Official

Name: SHELDON GROSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-873-3444