Healthcare Provider Details

I. General information

NPI: 1710944285
Provider Name (Legal Business Name): MAURO GROSSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOYE BLVD PCMH 288 WEST
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

600 MOYE BOULEVARD SUITE 333 PCMH MA
GREENVILLE NC
27834
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-4676
  • Fax: 252-744-8199
Mailing address:
  • Phone: 252-744-2087
  • Fax: 252-744-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number200500591
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: