MEDICARE: MACEY A 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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1912528027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACEY A GROSS

Provider Business Mailing Address
First Line	:	1 PRESTIGE PL STE 550
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-6115
Country	:	US
Telephone Number	:	937-558-3840
Fax Number	:	937-558-3844

Provider Business Practice Location Address
First Line	:	6438 WILMINGTON PIKE STE 100
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-7021
Country	:	US
Telephone Number	:	937-558-3840
Fax Number	:	937-558-3844

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

Provider Enumeration Date	:	04/29/2020
Last Update Date	:	03/19/2026

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