Active NPI
Leonard E Grosso, MD PHD
- Immunopathology Physician
- Saint Louis, MO
National Provider Identifier
1548280969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Immunopathology Physician
- License
- R6J66
- Practice address
- 1402 S Grand
St Louis, MO 63110 - Phone
- (314) 577-8693
- Fax
- (314) 268-5478
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Immunopathology Physician | 207ZI0100X | R6J66 | MO | Primary |
| Molecular Genetic Pathology (Pathology) Physician | 207ZP0007X | R6J66 | MO |
Addresses
Primary practice location
1402 S Grand
St Louis, MO 63110
Mailing address
3691 Rutger Ave
Provider Enrollment
St Louis, MO 63110
Phone (314) 977-4440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R6J66 | MO | MD | Immunopathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205798400000",
"number": "1548280969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3691 RUTGER AVE",
"address_2": "PROVIDER ENROLLMENT",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63110",
"telephone_number": "314-977-4440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 S GRAND",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63110",
"telephone_number": "314-577-8693",
"fax_number": "314-268-5478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSSO",
"first_name": "LEONARD",
"middle_name": "E",
"credential": "MD PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2008-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "207ZI0100X",
"taxonomy_group": "",
"desc": "Pathology, Immunopathology",
"state": "MO",
"license": "R6J66",
"primary": true
},
{
"code": "207ZP0007X",
"taxonomy_group": "",
"desc": "Pathology, Molecular Genetic Pathology",
"state": "MO",
"license": "R6J66",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.