Provider Demographics
NPI:1831353507
Name:GROSS, NICHOLAS ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ROBERT
Last Name:GROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:518 PELLIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4678
Mailing Address - Country:US
Mailing Address - Phone:724-832-2570
Mailing Address - Fax:724-832-2521
Practice Address - Street 1:518 PELLIS RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4678
Practice Address - Country:US
Practice Address - Phone:724-832-2570
Practice Address - Fax:724-832-2521
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS014865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine