Provider Demographics
NPI:1831327089
Name:GROSS, BRIAN CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:GROSS
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 1:1902 BRAEBURN DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7304
Mailing Address - Country:US
Mailing Address - Phone:540-444-2583
Mailing Address - Fax:540-772-2583
Practice Address - Street 1:1902 BRAEBURN DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7304
Practice Address - Country:US
Practice Address - Phone:540-444-2583
Practice Address - Fax:540-772-2583
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256274207Y00000X, 207Y00000X
MN53011207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1831327089Medicaid
SDENROLLEDMedicaid
MNENROLLEDMedicaid
MNP01070845OtherRAILROAD MEDICARE
IAENROLLEDMedicaid
VAVVF515AMedicare PIN
VA1831327089Medicaid
VAP01405328Medicare PIN