1467552588 NPI number — MARGARET GROSS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467552588 NPI number — MARGARET GROSS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GROSS

Provider First Name:

MARGARET

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1467552588

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/07/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

495 ROUTE 184 STE 120

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GROTON

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06340-6811

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

860-449-8882

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

495 ROUTE 184 STE 120

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GROTON

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06340-6811

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

860-449-8882

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  42172 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X , with the licence number: 042172 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 06-1556110 . This is a "NORTHEAST DIRECT" identifier . This identifiers is of the category "OTHER".
• Identifier: 2V5194 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
• Identifier: 06-1556110 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: P3304933 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 001421726-00 . This is a "BLUE CARE FAMILY PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 3512777 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 001421726 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 06-1556110 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 010042172CT01 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 06-1556110 . This is a "PIONEER" identifier . This identifiers is of the category "OTHER".
• Identifier: 06-1556110 . This is a "DIVERSIFIED" identifier . This identifiers is of the category "OTHER".
• Identifier: 06-1556110 . This is a "HEALTH CONNECTICUT" identifier . This identifiers is of the category "OTHER".