Provider Demographics
NPI:1184695512
Name:GROSSO, JOSEPH K (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:K
Last Name:GROSSO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 EAST BRADY ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4646
Mailing Address - Country:US
Mailing Address - Phone:724-284-4084
Mailing Address - Fax:724-284-4144
Practice Address - Street 1:911 EAST BRADY ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4646
Practice Address - Country:US
Practice Address - Phone:724-285-0823
Practice Address - Fax:724-282-7807
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000895L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA882105OtherHIGHMARK/KEYSTONE
PA209518OtherUPMC HEALTH PLANS
PA060052732OtherMEDICARE RAILROAD
PA251248890OtherINTERGROUP
PA60052732OtherUNITED HEALTHCARE
PAR06023OtherHEALTH AMERICA/ASSURANCE
PA209518OtherUPMC HEALTH PLANS
R06023Medicare UPIN
PA060052732OtherMEDICARE RAILROAD
PAR06023OtherHEALTH AMERICA/ASSURANCE