Provider Demographics
NPI:1215607049
Name:GROSSMAN, ANDREW BENJAMIN (PA-C, MMS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BENJAMIN
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N BAYSHORE DR APT 707
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3223
Mailing Address - Country:US
Mailing Address - Phone:786-585-2632
Mailing Address - Fax:
Practice Address - Street 1:1800 N BAYSHORE DR APT 707
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3223
Practice Address - Country:US
Practice Address - Phone:786-585-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant