Provider Demographics
NPI:1710944285
Name:GROSSI, MAURO (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURO
Middle Name:
Last Name:GROSSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 MOYE BOULEVARD SUITE 333
Mailing Address - Street 2:PCMH MA
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-744-2087
Mailing Address - Fax:252-744-8199
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:PCMH 288 WEST
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-4676
Practice Address - Fax:252-744-8199
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2005005912080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902660Medicaid
NC139TPOtherBCBS NC
NC2041446Medicare ID - Type Unspecified
NC5902660Medicaid
F28287Medicare UPIN
2041445Medicare PIN