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NPI Code Detail

MEDICARE: LAWRENCE GROSS

MEDICARE: LAWRENCE GROSS
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
12084P0800XPsychiatry PhysicianMD491038CPA
22084P0800XPsychiatry PhysicianD0101087MD
32084P0800XPsychiatry Physician1024512MA
42084P0800XPsychiatry Physician25IA12758200NJ
52084P0800XPsychiatry PhysicianC1-0028381DE

General Provider Information

NPI Number : 1134756711
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAWRENCE GROSS
Provider Business Mailing Address
First Line : 16 CAMELIA AVE
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02139-1008
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16 CAMELIA AVE
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02139-1008
Country : US
Telephone Number : 617-665-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2020
Last Update Date : 12/01/2025

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Directions to “ LAWRENCE GROSS ” Practice Location

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