MEDICARE: DR. MARIELLE SOPHIA GROSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD470686	PA
2	207V00000X	Obstetrics & Gynecology Physician	FG7823378	PA
3	207V00000X	Obstetrics & Gynecology Physician	4404	MD

General Provider Information

NPI Number	:	1023420486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIELLE SOPHIA GROSS M.D.

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:	717-851-6969

Provider Business Practice Location Address
First Line	:	12 ST PAUL DR
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1035
Country	:	US
Telephone Number	:	717-217-6882
Fax Number	:	717-255-0157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	03/18/2026

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