MEDICARE: DR. ROSS SANFORD MIDLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	41611	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	J06884	OTHER	MA	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1740280023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS SANFORD MIDLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8019
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01102-8000
Country	:	US
Telephone Number	:	866-431-4077
Fax Number	:	413-774-7448

Provider Business Practice Location Address
First Line	:	31 HALL DR
Second Line	:	AMHERST MEDICAL CENTER
City	:	AMHERST
State	:	MA
Zip	:	01002-2751
Country	:	US
Telephone Number	:	413-256-8561
Fax Number	:	413-256-4421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/16/2008

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