Provider Demographics
NPI:1659367233
Name:GROSSMAN, ALLAN MARC (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:MARC
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 1:1915 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2399
Mailing Address - Country:US
Mailing Address - Phone:865-541-1314
Mailing Address - Fax:865-541-2564
Practice Address - Street 1:1915 WHITE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2399
Practice Address - Country:US
Practice Address - Phone:865-541-1314
Practice Address - Fax:865-541-2564
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13403207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3708778Medicaid
TN3708778Medicare ID - Type Unspecified
TN3708778Medicaid