Provider Demographics
NPI:1912937905
Name:GROSS, BRION J (MD)
Entity Type:Individual
Prefix:
First Name:BRION
Middle Name:J
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4088
Practice Address - Fax:215-612-4323
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033761E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010835270009Medicaid
PA01083527-07OtherAMERICHOICE
PA153295OtherHIGHMARK BLUE SHIELD
PA153295OtherPERSONAL CHOICE
PA0010835270008Medicaid
PA01083527-08OtherAMERICHOICE
PA3056444OtherAETNA CONTRACT
PA0010835270007Medicaid
PA0084617000OtherKEYSTONE IBC
PA01083527-06OtherAMERICHOICE
PA30005228OtherKEYSTONE MERCY
PA9091440OtherCIGNA
PAP00002029OtherRAILROAD MEDICARE
PA0084617000OtherKEYSTONE IBC
PAC32076Medicare UPIN