Provider Demographics
NPI:1134129257
Name:GROSS, MONICA L (MD, MPH)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 KINGSTOWN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3239
Mailing Address - Country:US
Mailing Address - Phone:401-789-1086
Mailing Address - Fax:401-789-5344
Practice Address - Street 1:360 KINGSTOWN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3239
Practice Address - Country:US
Practice Address - Phone:401-789-1086
Practice Address - Fax:401-789-5344
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
040801208OtherMRO
RI9002666Medicaid
152368OtherTUFTS
RI01-01360OtherUNITED HEALTH PLAN
RI9000328Medicaid
080164988OtherRAILROAD MEDICARE
400265OtherBLUECHIP
RI1692OtherNHPRI
RI206343OtherBCBS
040801208OtherMRO
080164988OtherRAILROAD MEDICARE
RI9000328Medicaid