Provider Demographics
NPI:1598799025
Name:GROSSMAN, MARC MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:MICHAEL
Last Name:GROSSMAN
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 1:1 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2746
Mailing Address - Country:US
Mailing Address - Phone:603-421-2220
Mailing Address - Fax:
Practice Address - Street 1:1 PARKLAND DR
Practice Address - Street 2:PARKLAND MEDICAL CENTER
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:305-415-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93276207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME93276OtherMEDICAL LICENSE
NJMA70946OtherMEDICAL LICENSE
215356OtherMEDICAL LICENSE
215356OtherMEDICAL LICENSE
215356OtherMEDICAL LICENSE