Healthcare Provider Details

I. General information

NPI: 1710953658
Provider Name (Legal Business Name): CHRISTOPHER R ROSS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

IV. Provider business mailing address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1561
  • Fax: 207-626-1849
Mailing address:
  • Phone: 207-626-1561
  • Fax: 207-626-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA856
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: