Healthcare Provider Details

I. General information

NPI: 1841679347
Provider Name (Legal Business Name): ASHLEY VICTORIA WONG GROSSMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY WONG MD

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number60962
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60962
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: