Healthcare Provider Details

I. General information

NPI: 1700801875
Provider Name (Legal Business Name): ROBERT A GROSS MD.,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 WESTFALL RD BLDG C, STE 215
ROCHESTER NY
14618-2638
US

IV. Provider business mailing address

PO BOX 278984
ROCHESTER NY
14627-8984
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-7420
  • Fax: 585-756-2311
Mailing address:
  • Phone: 585-341-7420
  • Fax: 585-756-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number197683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: