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General NPI Number Information
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NPI Number | 1750321220
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Entity Type | Individual
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Provider Name | DHIMITRI ELICIA GROSS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 23000 MOAKLEY ST
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City | LEONARDTOWN
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State | MD
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Zip | 20650-2915
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Country | US
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Telephone | 240-744-1100
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Fax | 855-592-2119
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Provider Business Mailing Address
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Address Line | 1400 WEWATTA ST STE 350
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City | DENVER
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State | CO
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Zip | 80202-5553
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C4011
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0055146
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD490238C
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101222399
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13585-320
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License Number State | WI
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