Provider Demographics
NPI:1700801875
Name:GROSS, ROBERT A (MD,PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278984
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14627-8984
Mailing Address - Country:US
Mailing Address - Phone:585-341-7420
Mailing Address - Fax:585-756-2311
Practice Address - Street 1:919 WESTFALL RD
Practice Address - Street 2:BLDG C, STE 215
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2638
Practice Address - Country:US
Practice Address - Phone:585-341-7420
Practice Address - Fax:585-756-2311
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1976832084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01616339Medicaid
MDA946OtherPREFERRED CARE
P010197683OtherBLUE CHOICE
00040114001OtherUNIVERA
5059134OtherAETNA
6325OtherBLUE SHIELD
P010197683OtherBLUE CHOICE
5059134OtherAETNA