Provider Demographics
NPI:1851384523
Name:GROSS, PUSHPA LALL (MD)
Entity Type:Individual
Prefix:
First Name:PUSHPA
Middle Name:LALL
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 LAWYERS RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3906
Mailing Address - Country:US
Mailing Address - Phone:704-537-0020
Mailing Address - Fax:704-537-2144
Practice Address - Street 1:7110 LAWYERS RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3906
Practice Address - Country:US
Practice Address - Phone:704-537-0020
Practice Address - Fax:704-537-2144
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8937736Medicaid
NCF60069Medicare UPIN
NC2153324DMedicare ID - Type Unspecified