Provider Demographics
NPI:1144269713
Name:GROSS, SHARON C IV (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:C
Last Name:GROSS
Suffix:IV
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3449 WILKENS AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5281
Mailing Address - Country:US
Mailing Address - Phone:410-644-7544
Mailing Address - Fax:410-644-2451
Practice Address - Street 1:3449 WILKENS AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5281
Practice Address - Country:US
Practice Address - Phone:410-644-7544
Practice Address - Fax:410-644-2451
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD37085207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530751100Medicaid
MD40165002OtherBLUE CROSS BLUE SHIELD
MD530751100Medicaid
MDD76644Medicare UPIN