Provider Demographics
NPI:1467552588
Name:GROSS, MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
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 1:1 WAHOO AVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-2324
Mailing Address - Country:US
Mailing Address - Phone:860-694-7524
Mailing Address - Fax:860-694-1209
Practice Address - Street 1:1 WAHOO AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-2324
Practice Address - Country:US
Practice Address - Phone:860-694-7524
Practice Address - Fax:860-694-1209
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-1556110OtherCIGNA
06-1556110OtherDIVERSIFIED
3512777OtherAETNA
2V5194OtherHEALTH NET
P3304933OtherOXFORD
CT001421726Medicaid
001421726-00OtherBLUE CARE FAMILY PLAN
010042172CT01OtherBLUE CROSS
06-1556110OtherHEALTH CONNECTICUT
06-1556110OtherUNITED HEALTHCARE
06-1556110OtherPIONEER
06-1556110OtherNORTHEAST DIRECT