Provider Demographics
NPI:1487606786
Name:GROSS, MARIA L (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:GROSS
Suffix:
Gender:F
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6622
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:7206 MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4507
Practice Address - Country:US
Practice Address - Phone:330-726-3379
Practice Address - Fax:330-726-8683
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-078917207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2463169Medicaid
OH000000532492OtherANTHEM
OH2463169Medicaid
OH$$$$$$$$$006OtherMEDICAL MUTUAL
OH000000532492OtherANTHEM
I02483Medicare UPIN
OHGR4128113Medicare ID - Type Unspecified