Provider Demographics
NPI:1649266610
Name:GROSS, GEORGE W (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 17383
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1383
Mailing Address - Country:US
Mailing Address - Phone:410-328-5656
Mailing Address - Fax:410-328-2115
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:ROOM N2E23
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5656
Practice Address - Fax:410-328-2115
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00566832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH38067SSMedicare PIN
MDC31898Medicare UPIN
MD865L68SSMedicare PIN