Provider Demographics
NPI:1043422306
Name:GROSSMAN, MARC JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JONATHAN
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6000 EXECUTIVE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:240-207-2030
Mailing Address - Fax:301-468-0614
Practice Address - Street 1:6000 EXECUTIVE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:240-207-2030
Practice Address - Fax:301-468-0614
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066318208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation