Provider Demographics
NPI:1881673846
Name:GROSSMAN, JORDAN P (DPM)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:P
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:#440
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-1980
Mailing Address - Fax:330-344-6038
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:#440
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-1980
Practice Address - Fax:330-344-6038
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003133G213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OHP00431103OtherRAILROAD MEDICARE PTAN
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2209621Medicaid
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1232120008Medicare NSC
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH1232120019Medicare NSC
OH1232120011Medicare NSC