MEDICARE: PATRICK JACOB GROSS D.O.

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	208000000X	Pediatrics Physician	34010958	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962644054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK JACOB GROSS D.O.

Provider Business Mailing Address
First Line	:	5400 FRANTZ RD
Second Line	:	SUITE 250
City	:	DUBLIN
State	:	OH
Zip	:	43016-4144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10401 SAWMILL PKWY
Second Line	:	SUITE 20
City	:	POWELL
State	:	OH
Zip	:	43065-7451
Country	:	US
Telephone Number	:	614-764-9955
Fax Number	:	614-792-5086

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

Provider Enumeration Date	:	04/03/2009
Last Update Date	:	01/05/2022

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