Provider Demographics
NPI:1093717969
Name:GROSS, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 N MCCORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1702
Mailing Address - Country:US
Mailing Address - Phone:419-843-8180
Mailing Address - Fax:419-841-7038
Practice Address - Street 1:3020 N MCCORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1702
Practice Address - Country:US
Practice Address - Phone:419-843-8180
Practice Address - Fax:419-841-7038
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3505718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0634698OtherAETNA
OH9806OtherHPM
OH0742147Medicaid
OH00721OtherPARAMOUNT
OH04-03001OtherUHC
OH000000141259OtherANTHEM
OH9806OtherHPM
OHGR0644766Medicare ID - Type Unspecified