Provider Demographics
NPI:1265653331
Name:GROSS, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:966 HUNGERFORD DR
Mailing Address - Street 2:STE 2
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1714
Mailing Address - Country:US
Mailing Address - Phone:301-251-2323
Mailing Address - Fax:301-340-6769
Practice Address - Street 1:966 HUNGERFORD DR
Practice Address - Street 2:STE 2
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1714
Practice Address - Country:US
Practice Address - Phone:301-251-2323
Practice Address - Fax:301-340-6769
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00316662084P0800X
MDD316662084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD623511500Medicaid
C8888Medicare UPIN
MD623511500Medicaid