Provider Demographics
NPI:1942798608
Name:GROSS, ANDREW JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JONATHAN
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 1:11919 CLARIDON TROY RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-8441
Mailing Address - Country:US
Mailing Address - Phone:330-805-0162
Mailing Address - Fax:
Practice Address - Street 1:9485 MENTOR AVE STE 3
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8711
Practice Address - Country:US
Practice Address - Phone:440-205-5788
Practice Address - Fax:440-205-5781
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1479542085R0001X
OH57.246406390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program