Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101044493 | VA |
NPI | 1073682605 |
---|---|
Provider Name | Charles W. Gross |
First Address | Charlottesville, VA 22903-2981 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |