Healthcare Provider Details

I. General information

NPI: 1154384774
Provider Name (Legal Business Name): MARTIN A. GROSSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 W PALMETTO PARK RD STE 15-847
BOCA RATON FL
33433-3426
US

IV. Provider business mailing address

7050 W PALMETTO PARK RD STE 15-847
BOCA RATON FL
33433-3426
US

V. Phone/Fax

Practice location:
  • Phone: 917-202-9070
  • Fax:
Mailing address:
  • Phone: 917-202-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35.145785
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2022044819
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number199759
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number25MA11014800
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD50899
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number35.145785
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number92236
License Number StateGA
# 8
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME144803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: