Basic Information
| Provider Information | |||||||||
| NPI: | 1013101260 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARC GROSSMAN, M.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 EXECUTIVE BLVD | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208523803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017707900 | ||||||||
| FaxNumber: | 3017707904 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 EXECUTIVE BLVD | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208523803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017707900 | ||||||||
| FaxNumber: | 3017707904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2007 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | GROSSMAN | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | JONATHAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3017707900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | D0066318 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.