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General NPI Number Information
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NPI Number | 1942798608
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Entity Type | Individual
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Provider Name | ANDREW JONATHAN GROSS MD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2018
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 9485 MENTOR AVE STE 3
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City | MENTOR
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State | OH
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Zip | 44060-8711
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Country | US
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Telephone | 440-205-5788
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Fax | 440-205-5781
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Provider Business Mailing Address
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Address Line | 11919 CLARIDON TROY RD
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City | CHARDON
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State | OH
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Zip | 44024-8441
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Country | US
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Telephone | 330-805-0162
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 35.147954
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 57.246406
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License Number State | OH
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