Provider Demographics
NPI:1942352075
Name:GROSSMAN, MARGARET L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:L
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2778 BUTTERMILK LN
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6937
Mailing Address - Country:US
Mailing Address - Phone:707-826-2819
Mailing Address - Fax:
Practice Address - Street 1:801 CRESCENT WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6780
Practice Address - Country:US
Practice Address - Phone:707-822-5900
Practice Address - Fax:707-822-4190
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE65334Medicare UPIN