MEDICARE: LIZA JANE GROSSMAN MD

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	390200000X	Student in an Organized Health Care Education/Training Program		WV

General Provider Information

NPI Number	:	1093653297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZA JANE GROSSMAN MD

Provider Business Mailing Address
First Line	:	315 MAPLE AVE
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1815
Country	:	US
Telephone Number	:	304-672-6809
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 CHESTNUT RIDGE RD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-2854
Country	:	US
Telephone Number	:	304-293-5323
Fax Number	:	304-293-8724

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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