Provider Demographics
NPI:1396048005
Name:S WARREN GROSS MD LLC
Entity type:Organization
Organization Name:S WARREN GROSS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-331-4360
Mailing Address - Street 1:131 GAITHER DR STE D
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1709
Mailing Address - Country:US
Mailing Address - Phone:856-234-1241
Mailing Address - Fax:856-234-5608
Practice Address - Street 1:331 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2230
Practice Address - Country:US
Practice Address - Phone:856-809-0900
Practice Address - Fax:888-268-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA058277002085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty