Provider Demographics
NPI:1912192030
Name:RICHARD A. GROSS, M.D., P.C.
Entity Type:Organization
Organization Name:RICHARD A. GROSS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-947-7673
Mailing Address - Street 1:339 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2143
Mailing Address - Country:US
Mailing Address - Phone:508-947-7673
Mailing Address - Fax:508-947-6336
Practice Address - Street 1:339 CENTER ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2143
Practice Address - Country:US
Practice Address - Phone:508-947-7673
Practice Address - Fax:508-947-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA712579OtherTUFTS
MAJ17026OtherBCBC/MA
MA9725636Medicaid
MA9725636Medicaid