Provider Demographics
NPI:1750638243
Name:GROSSGOLD, ANDREAS MENESSES (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:MENESSES
Last Name:GROSSGOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3335
Mailing Address - Country:US
Mailing Address - Phone:727-900-7011
Mailing Address - Fax:727-223-5151
Practice Address - Street 1:609 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3335
Practice Address - Country:US
Practice Address - Phone:727-900-7011
Practice Address - Fax:727-491-5624
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113826207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1093617OtherCAREPLUS
FL006688000Medicaid
FL4105492OtherCIGNA
FL1093617OtherCAREPLUS