Healthcare Provider Details

I. General information

NPI: 1235128315
Provider Name (Legal Business Name): CLEMENS MARTIN GROSSKINSKY PHD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 12/14/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LENNON LN LASSEN BUILDING, 2ND FLOOR, SUITE 5B
WALNUT CREEK CA
94598-2419
US

IV. Provider business mailing address

54 SAN GREGORIO CT
DANVILLE CA
94526-1544
US

V. Phone/Fax

Practice location:
  • Phone: 925-906-2329
  • Fax: 925-906-4870
Mailing address:
  • Phone: 614-266-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35066572G
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG87868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: