Healthcare Provider Details

I. General information

NPI: 1689596447
Provider Name (Legal Business Name): GROSSMAN ORTHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6176 ISLAND BND APT D
BOCA RATON FL
33496-3271
US

IV. Provider business mailing address

1558 HANE ST
MC LEAN VA
22101-4438
US

V. Phone/Fax

Practice location:
  • Phone: 301-440-1620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD GROSSMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 301-440-1620