Individual
TYLER ROSS GRENDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 WALNUT ST FL 5, PHILADELPHIA, PA 19107-4944
(215) 955-6750
Mailing address
1025 WALNUT ST STE 607, PHILADELPHIA, PA 19107-5001
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD468465
PA
390200000X
Student in an Organized Health Care Education/Training Program
4301097169
MI
Other
Enumeration date
05/19/2010
Last updated
08/30/2019
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