Healthcare Provider Details

I. General information

NPI: 1831327089
Provider Name (Legal Business Name): BRIAN CHRISTOPHER GROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 01/14/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 BRAEBURN DR SUITE 130
SALEM VA
24153-7304
US

IV. Provider business mailing address

1902 BRAEBURN DR SUITE 130
SALEM VA
24153-7304
US

V. Phone/Fax

Practice location:
  • Phone: 540-444-2583
  • Fax: 540-772-2583
Mailing address:
  • Phone: 540-444-2583
  • Fax: 540-772-2583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101256274
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: