Provider Demographics
NPI:1700843117
Name:GROSSMAN, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-528-1290
Mailing Address - Fax:818-528-1295
Practice Address - Street 1:18375 VENTURA BLVD
Practice Address - Street 2:SUITE 640
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4218
Practice Address - Country:US
Practice Address - Phone:818-908-8048
Practice Address - Fax:818-908-8072
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2016-05-03
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Provider Licenses
StateLicense IDTaxonomies
CAA52722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A527220OtherBLUE SHIELD
CAWA52722EMedicare PIN
G01148Medicare UPIN