| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MARK LAND GROSSETETE | 1447592498 | 2024-01-08 |
Mark L Grossetete [M] graduated in 2013 from University Of New Mexico School Of Medicine and primarily specializes in Neurology.
Mark Land Grossetete is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1447592498. Registration indicates Mark Land Grossetete is a provider of services with a specialization in Allopathic & Osteopathic Physicians, Anesthesiology (Anesthesiology, ) (All Other Specialties & Provider Types, ) (Anesthesiology, Allopathic & Osteopathic Physicians) (Allopathic & Osteopathic Physicians, Anesthesiology) (Anesthesiology: Addiction Medicine, ) (Anesthesiology Addiction Medicine, Allopathic & Osteopathic Physicians) (Anesthesiology, ) Access to Adult/Geriatric Primary Care Providers (Allopathic & Osteopathic Physicians, Internal Medicine) Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, Internal Medicine) (Internal Medicine, ) (Allopathic & Osteopathic Physicians, Internal Medicine) (Primary Care/Family Planning/APRN/PA, ) (Internal Medicine, Allopathic & Osteopathic Physicians) (Allopathic & Osteopathic Physicians, Pain Medicine) (Pain Medicine: Pain Medicine, ) (Specialist Network, ) (Pain Medicine Pain Medicine, Allopathic & Osteopathic Physicians) (Pain Medicine, ) (Student, Health Care, Student in an Organized Health Care Education/Training Program) (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care) (Allopathic & Osteopathic Physicians, Psychiatry & Neurology) (Psychiatry & Neurology: Neurology, ) (Specialist Network, ) (Psychiatry & Neurology Neurology, Allopathic & Osteopathic Physicians) (Psychiatry & Neurology, )
| PECOS ID | 3577798909 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Dr. Mark Land Grossetete M.D., PH.D. |
| Practice Office Address | 117 CAMINO DE VIDA STE 300 SANTA ROSA, NM US |
| Practice Office Telephone | 5754724311 |
| Practice Office Fax | 5754724313 |
| Mailing Address | 117 CAMINO DE VIDA STE 300 SANTA ROSA, NM 884352267 US |
| Business Telephone | 5754724311 |
| Code | Practice | License No State |
|---|---|---|
| 207L00000X | Allopathic & Osteopathic Physicians Anesthesiology Anesthesiology All Other Specialties & Provider Types Anesthesiology Allopathic & Osteopathic Physicians | MD2017-0779
NM |
| 207LA0401X | Allopathic & Osteopathic Physicians Anesthesiology Anesthesiology: Addiction Medicine Anesthesiology Addiction Medicine Allopathic & Osteopathic Physicians Anesthesiology | MD2017-0779
NM |
| 207R00000X | Access to Adult/Geriatric Primary Care Providers Allopathic & Osteopathic Physicians Internal MedicineAccess to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians Internal Medicine Internal Medicine Allopathic & Osteopathic Physicians Internal Medicine Primary Care/Family Planning/APRN/PA Internal Medicine Allopathic & Osteopathic Physicians | MD2017-0779
NM |
| 208VP0000X | Allopathic & Osteopathic Physicians Pain Medicine Pain Medicine: Pain Medicine Specialist Network Pain Medicine Pain Medicine Allopathic & Osteopathic Physicians Pain Medicine | MD2017-0779
NM |
| 390200000X | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |
NM |
| 2084N0400X PRIMARY | Allopathic & Osteopathic Physicians Psychiatry & Neurology Psychiatry & Neurology: Neurology Specialist Network Psychiatry & Neurology Neurology Allopathic & Osteopathic Physicians Psychiatry & Neurology | MD2017-0779
NM |