Provider Demographics
NPI:1952755464
Name:GROSS, DANIEL A (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-638-6950
Practice Address - Fax:617-638-6966
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA290947207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110186893AMedicaid
MA290947OtherMASSACHUSETTS BOARD OF REGISTRATION IN MEDICINE
NH3135961Medicaid