Provider Demographics
NPI:1972501971
Name:GROSSMAN, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 REGENCY COURT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-517-8000
Mailing Address - Fax:419-517-8003
Practice Address - Street 1:1000 REGENCY COURT
Practice Address - Street 2:SUITE 102
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-517-8000
Practice Address - Fax:419-517-8003
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110176066OtherRRMC
OH0335006Medicaid
OH29942551-00OtherBWC
OH07-55915OtherUHC
OH00183OtherPARAMOUNT
OH000000141256OtherANTHEM
OH0633292OtherAETNA
OHA75850Medicare UPIN
OHGRO433865Medicare PIN