Provider Demographics
NPI:1811970148
Name:GROSSBERG, JUDITH PRITIKIN (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:PRITIKIN
Last Name:GROSSBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 HUGUENOT RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2618
Mailing Address - Country:US
Mailing Address - Phone:804-794-2299
Mailing Address - Fax:804-794-5774
Practice Address - Street 1:1407 HUGUENOT RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2618
Practice Address - Country:US
Practice Address - Phone:804-794-2299
Practice Address - Fax:804-794-5774
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA559426OtherAETNA
VA817869OtherALLIANCE MAMSI
VA817869OtherALLIANCE MAMSI