Healthcare Provider Details

I. General information

NPI: 1831185719
Provider Name (Legal Business Name): DOUGLAS S ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST THYROID UNIT WAC 730 MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114-3117
US

IV. Provider business mailing address

15 PARKMAN ST THYROID UNIT WAC 730 MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114-3117
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3872
  • Fax: 617-726-5905
Mailing address:
  • Phone: 617-726-3872
  • Fax: 617-726-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number45888
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: