Provider Demographics
NPI:1205432945
Name:GROSSMAN, CHRISTINA ANN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 EMBERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1908
Mailing Address - Country:US
Mailing Address - Phone:614-327-4694
Mailing Address - Fax:
Practice Address - Street 1:6212 EMBERWOOD RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1908
Practice Address - Country:US
Practice Address - Phone:614-327-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2562294Medicaid