Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 6926 | SC |
NPI | 1023068897 |
---|---|
Provider Name | Dr. William J Grossman |
First Address | Charleston, SC 29403 |
Second Address | Charleston, SC 29403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 05/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069268 | (05) | SC |
D05558 | (02) | SC |