Healthcare Provider Details

I. General information

NPI: 1689867814
Provider Name (Legal Business Name): DR. PAMELA GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 US ROUTE 5
WESTMINSTER VT
05158-9651
US

IV. Provider business mailing address

219 MISSIONARY DR
DECATUR GA
30030-3842
US

V. Phone/Fax

Practice location:
  • Phone: 802-722-4023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number042589
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number042.0019057
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: