Healthcare Provider Details

I. General information

NPI: 1235201427
Provider Name (Legal Business Name): ERIK TODD GROSSGOLD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

PO BOX 896263
CHARLOTTE NC
28289-6263
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-7392
  • Fax: 910-615-7392
Mailing address:
  • Phone: 910-615-7070
  • Fax: 910-321-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0101240252
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2019-00141
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101240252
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: