Healthcare Provider Details

I. General information

NPI: 1275205650
Provider Name (Legal Business Name): MEGAN RUOSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 HOSPITAL DR
GLEN BURNIE MD
21061-5805
US

IV. Provider business mailing address

13925 WHETSTONE MANOR CT
CLIFTON VA
20124-2530
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-8100
  • Fax:
Mailing address:
  • Phone: 703-887-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC088246
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: