Provider Demographics
NPI:1649335803
Name:GROSS, RACHEL G (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:G
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ELISABETH
Other - Last Name:GOLDMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:510 DELANCEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4106
Mailing Address - Country:US
Mailing Address - Phone:215-806-4296
Mailing Address - Fax:
Practice Address - Street 1:135 S 19TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4912
Practice Address - Country:US
Practice Address - Phone:610-314-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1860622084N0400X
PAMD4332902084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology