Healthcare Provider Details

I. General information

NPI: 1811916463
Provider Name (Legal Business Name): ROBERT RICHARD ROSS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/12/2025
Certification Date: 06/22/2025
Deactivation Date: 06/22/2025
Reactivation Date: 08/06/2025

III. Provider practice location address

2000 GREEN RD. SUITE 100
ANN ARBOR MI
48105
US

IV. Provider business mailing address

NORTHERN LIGHT EASTERN MAINE MEDICAL CENTER-EMERGENCY C 489 STATE STREET
BANGOR ME
04401
US

V. Phone/Fax

Practice location:
  • Phone: 374-995-3764
  • Fax: 208-475-9028
Mailing address:
  • Phone: 207-973-8000
  • Fax: 207-273-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2870
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001593
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2870
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: