Basic Information
| Provider Information | |||||||||
| NPI: | 1568558625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9816 MAYLAND DR | ||||||||
| Address2: | 100 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232331457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042828510 | ||||||||
| FaxNumber: | 8042855750 | ||||||||
| Practice Location | |||||||||
| Address1: | 9816 MAYLAND DR | ||||||||
| Address2: | 100 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232331457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042828510 | ||||||||
| FaxNumber: | 8042855750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 02/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 0101243534 | VA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 070000459 | 01 | VA | MEDICARE | OTHER | 1568558625 | 01 | VA | UNITED HEALTHCARE | OTHER | 355555 | 01 | VA | ANTHEM | OTHER | 885825 | 01 | VA | SOUTHERN HEALTH | OTHER | 3183614 | 01 | VA | AETNA | OTHER | 9186914 | 01 | VA | CIGNA | OTHER |