Provider Demographics
NPI:1013916717
Name:GROSS, WAYNE D (DO)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:D
Last Name:GROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:323 MARION AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3639
Mailing Address - Country:US
Mailing Address - Phone:330-837-1111
Mailing Address - Fax:330-837-1769
Practice Address - Street 1:323 MARION AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3639
Practice Address - Country:US
Practice Address - Phone:330-837-1111
Practice Address - Fax:330-837-1769
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2010-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34005735207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0925280Medicaid
OHGR0740081Medicare ID - Type Unspecified
OH0925280Medicaid