Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC-003788-L | PA |
Y | 222Z00000X | Podiatrist | SC-003788-L | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC-003788-L | PA |
N | 213ES0131X | Foot Surgery | SC-003788-L | PA |
NPI | 1336219591 |
---|---|
Provider Name | Dr. Adam David Grossman |
First Address | Washington, PA 15301-4941 |
Second Address | Washington, PA 15301-4941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 24/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01402683 | (05) | PA |
U40828 | (02) | PA |