Provider Demographics
NPI:1639302789
Name:GROSSMAN, ROBERT KIM
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KIM
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4160
Mailing Address - Country:US
Mailing Address - Phone:434-792-4378
Mailing Address - Fax:434-799-0860
Practice Address - Street 1:159 EXECUTIVE DR
Practice Address - Street 2:SUITE F
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-792-4378
Practice Address - Fax:434-799-0860
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168401364SA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health