Provider Demographics
NPI:1881884492
Name:ROBERT A GROSS, M. D. INC.
Entity type:Organization
Organization Name:ROBERT A GROSS, M. D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:310-204-4044
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:SUITE 706
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2751
Mailing Address - Country:US
Mailing Address - Phone:310-204-4044
Mailing Address - Fax:310-204-1449
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 706
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-204-4044
Practice Address - Fax:310-204-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A41251Medicare UPIN