Provider Demographics
NPI:1073672887
Name:GROSS, JOYCE YUDITH (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:YUDITH
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 WOODBOX LN
Mailing Address - Street 2:UNIT C
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1657
Mailing Address - Country:US
Mailing Address - Phone:410-484-5508
Mailing Address - Fax:410-484-6475
Practice Address - Street 1:2103 WOODBOX LN
Practice Address - Street 2:UNIT C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1657
Practice Address - Country:US
Practice Address - Phone:410-484-5508
Practice Address - Fax:410-484-6475
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD03843JY11OtherBLUE CROSS BLUE SHIELD
MD03843JY11OtherBLUE CROSS BLUE SHIELD
MDA72719Medicare UPIN