Provider Demographics
NPI:1891771168
Name:GROSSMAN, LAUREN SUE (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:SUE
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:701 E EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2833
Practice Address - Country:US
Practice Address - Phone:650-934-7800
Practice Address - Fax:650-934-7843
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG152577202D00000X, 207P00000X
CO41768207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG152577OtherSTATE MEDICAL LICENSE
CO66057337Medicaid
COG84148Medicare UPIN