Provider Demographics
NPI:1710995543
Name:GROSS, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:613 LONG POINT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8350
Mailing Address - Country:US
Mailing Address - Phone:843-724-3456
Mailing Address - Fax:843-724-3455
Practice Address - Street 1:613 LONG POINT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8350
Practice Address - Country:US
Practice Address - Phone:843-724-3456
Practice Address - Fax:843-724-3455
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2021-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NCNC200201921207W00000X
SC29610207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ0098FMedicaid
NCH92934Medicare UPIN
SCQ0098FMedicaid
NC2021829AMedicare ID - Type Unspecified