Healthcare Provider Details

I. General information

NPI: 1851384523
Provider Name (Legal Business Name): PUSHPA LALL GROSS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 LAWYERS RD
MINT HILL NC
28227-3906
US

IV. Provider business mailing address

7110 LAWYERS RD
MINT HILL NC
28227-3906
US

V. Phone/Fax

Practice location:
  • Phone: 704-537-0020
  • Fax: 704-537-2144
Mailing address:
  • Phone: 704-537-0020
  • Fax: 704-537-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30349
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: