Basic Information
| Provider Information | |||||||||
| NPI: | 1447241963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | LAWRENCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 HEARTHSTONE CT | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196063065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107799550 | ||||||||
| FaxNumber: | 6107796433 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 HEARTHSTONE CT | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196063065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107799550 | ||||||||
| FaxNumber: | 6107796433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD016341E | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | MD016341E | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000624121 | 05 | PA | MEDICAID |