Provider Demographics
NPI:1598871097
Name:GROSS, PAUL K (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:K
Last Name:GROSS
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 1:1245 SOUTH CEDAR CREST BLVD.
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-820-3900
Mailing Address - Fax:610-820-8647
Practice Address - Street 1:1245 SOUTH CEDAR CREST BLVD.
Practice Address - Street 2:SUITE 303
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-820-3900
Practice Address - Fax:610-820-8647
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014403E2084F0202X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005529530001Medicaid
004780000OtherMAGELLAN
PA260045197OtherRAILROAD MEDICARE
PA163384OtherHIGHMARK BLUE SHIELD
P711319OtherOXFORD
PA01197501OtherCAPITAL BLUE CROSS
PA260045197OtherRAILROAD MEDICARE
PA0005529530001Medicaid