Individual
DR. MICHAEL LESLIE GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
828 HEALTHY WAY, SUITE 300, VIRGINIA BEACH, VA 23462-7958
(757) 965-6165
(757) 965-6296
Mailing address
828 HEALTHY WAY, SUITE 300, VIRGINIA BEACH, VA 23462-7958
(757) 965-6165
(757) 965-6296
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101052313
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070008396
RR MEDICARE
VA
01
—
075428
ANTHEM BC/BS
VA
05
—
5900379
—
VA
01
—
77060
OPTIMA
VA
01
—
890625A
NC MEDICAID
NC
Enumeration date
06/22/2005
Last updated
05/23/2012
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