Provider Demographics
NPI:1306909338
Name:GROSS, PETER L (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0447
Mailing Address - Country:US
Mailing Address - Phone:410-535-4116
Mailing Address - Fax:410-414-8480
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 215
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4019
Practice Address - Country:US
Practice Address - Phone:410-535-4116
Practice Address - Fax:410-414-8480
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD5012163WU0100X
VA0101038308163WU0100X
MDD0057592208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D18134Medicare UPIN
008490M92Medicare ID - Type Unspecified