Healthcare Provider Details

I. General information

NPI: 1659367233
Provider Name (Legal Business Name): ALLAN MARC GROSSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 WHITE AVE
KNOXVILLE TN
37916-2399
US

IV. Provider business mailing address

1915 WHITE AVE
KNOXVILLE TN
37916-2399
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-1314
  • Fax: 865-541-2564
Mailing address:
  • Phone: 865-541-1314
  • Fax: 865-541-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD13403
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: