Healthcare Provider Details

I. General information

NPI: 1538144704
Provider Name (Legal Business Name): MARVIN N GROSSMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2005
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 S MAIN ST
NORTH CANTON OH
44720-4271
US

IV. Provider business mailing address

1266 S MAIN ST
NORTH CANTON OH
44720-4271
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-2700
  • Fax: 330-494-6898
Mailing address:
  • Phone: 330-494-2700
  • Fax: 330-494-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36001528
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: