Provider Demographics
NPI:1508054255
Name:MARTIN B GROSSMAN MD PA
Entity Type:Organization
Organization Name:MARTIN B GROSSMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-936-2565
Mailing Address - Street 1:20950 NE 27TH CT
Mailing Address - Street 2:STE 302
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1232
Mailing Address - Country:US
Mailing Address - Phone:305-936-2565
Mailing Address - Fax:305-936-1946
Practice Address - Street 1:20950 NE 27TH CT
Practice Address - Street 2:STE 302
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1232
Practice Address - Country:US
Practice Address - Phone:305-936-2565
Practice Address - Fax:305-936-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBF560Medicare PIN