Provider Demographics
NPI:1609820372
Name:GROSMAN, IRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:GROSMAN
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 1:405 N OCEAN BLVD APT 1501
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5153
Mailing Address - Country:US
Mailing Address - Phone:347-400-0405
Mailing Address - Fax:954-785-3142
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:HOLY CROSS HOSPITAL DEPARTMENT OF RADIATION
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-492-5764
Practice Address - Fax:954-776-3238
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 710962085R0203X
NJ25MA064498002085R0203X
NY196838-12085R0203X
PAMD058312L2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2743841 00Medicaid
FL03227Medicare ID - Type Unspecified
FL2743841 00Medicaid