Healthcare Provider Details

I. General information

NPI: 1134129257
Provider Name (Legal Business Name): MONICA L GROSS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 KINGSTOWN RD SUITE 104
NARRAGANSETT RI
02882-3239
US

IV. Provider business mailing address

360 KINGSTOWN RD SUITE 104
NARRAGANSETT RI
02882-3239
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-1086
  • Fax: 401-789-5344
Mailing address:
  • Phone: 401-789-1086
  • Fax: 401-789-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD09154
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: