Provider Demographics
NPI:1235128315
Name:GROSSKINSKY, CLEMENS MARTIN (PHD, MD)
Entity Type:Individual
Prefix:
First Name:CLEMENS
Middle Name:MARTIN
Last Name:GROSSKINSKY
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SAN GREGORIO CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1544
Mailing Address - Country:US
Mailing Address - Phone:614-266-9355
Mailing Address - Fax:
Practice Address - Street 1:320 LENNON LN
Practice Address - Street 2:LASSEN BUILDING, 2ND FLOOR, SUITE 5B
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2419
Practice Address - Country:US
Practice Address - Phone:925-906-2329
Practice Address - Fax:925-906-4870
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066572G207VE0102X
CAG87868207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0264235Medicaid
OH0264235Medicaid