Provider Demographics
NPI:1972565661
Name:GROSS, KATHY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:LYNN
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:114 KINDERTON BLVD
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-7302
Practice Address - Country:US
Practice Address - Phone:336-998-9742
Practice Address - Fax:336-998-9410
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC27464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911983Medicaid