Provider Demographics
NPI:1518945336
Name:GROSS, RICHARD HENRY (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HENRY
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:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5791
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:108 MOSBY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-9411
Practice Address - Country:US
Practice Address - Phone:252-586-5411
Practice Address - Fax:252-586-2028
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34617208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC37749OtherBLUE CROSS BLUE SHIELD #
NC010058564OtherRAILROAD MEDICARE #
NC34617OtherNC MEDICAL LICENSE #
NC64970OtherMEDCOST LLC PROVIDER #
PAMD006531EOtherPA MEDICAL LICENSE #
NC8937749Medicaid
NC8937749Medicaid
NC64970OtherMEDCOST LLC PROVIDER #
NC8937749Medicaid