Healthcare Provider Details

I. General information

NPI: 1093711418
Provider Name (Legal Business Name): JEROME ROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PINE HEIGHTS AVE
BALTIMORE MD
21229-5208
US

IV. Provider business mailing address

1001 PINE HEIGHTS AVE
BALTIMORE MD
21229-5208
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-9515
  • Fax: 410-644-8250
Mailing address:
  • Phone: 410-644-9515
  • Fax: 410-644-8250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0009835
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: