Provider Demographics
NPI:1205822046
Name:GROSSMAN, ALLAN B (DPM)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:B
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E GUDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1496
Mailing Address - Country:US
Mailing Address - Phone:717-732-7056
Mailing Address - Fax:
Practice Address - Street 1:4033 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1153
Practice Address - Country:US
Practice Address - Phone:717-651-0000
Practice Address - Fax:717-651-0001
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003731-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001634338Medicaid
PA001634338Medicaid
PA78463NLHMedicare ID - Type Unspecified