Provider Demographics
NPI:1124092739
Name:GROSSMAN, GILBERT (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:GROSSMAN
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 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLR.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:267-479-4142
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:700 COTTMAN AVE
Practice Address - Street 2:BLDG B, SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-745-4100
Practice Address - Fax:215-745-9565
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026156L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000741351 0018Medicaid
PA015570GT6Medicare PIN