Provider Demographics
NPI:1346229127
Name:GROSS, NED JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:NED
Middle Name:JAY
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 1:314 FAIRY STREET EXT
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1913
Mailing Address - Country:US
Mailing Address - Phone:276-666-8439
Mailing Address - Fax:276-666-8440
Practice Address - Street 1:314 FAIRY STREET EXT
Practice Address - Street 2:SUITE D
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1913
Practice Address - Country:US
Practice Address - Phone:276-666-8439
Practice Address - Fax:276-666-8440
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000811207N00000X
VA0101228761207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA1547OtherMEDCOST
VA070015390OtherRAILROAD MEDICARE
VA005900646Medicaid
NC070015616OtherRAILROAD MEDICARE
NCA1547OtherMEDCOST
NC0308562OtherUNITED HEALTHCARE
NC89127C5Medicaid
VA7336555001OtherCIGNA
VA7986163OtherAETNA
NC127C5OtherBLUE CROSS BLUE SHIELD NC
VA285584OtherANTHEM
NC7336555OtherCIGNA
NC7986163OtherAETNA
VA005900646Medicaid
VA070000315Medicare ID - Type UnspecifiedINDIVIDUAL
VA285584OtherANTHEM
NC2281027Medicare ID - Type UnspecifiedINDIVIDUAL