Healthcare Provider Details

I. General information

NPI: 1174538672
Provider Name (Legal Business Name): ROSS MICHAEL UNGERLEIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

PO BOX 344
WINSTON-SALEM NC
27102-0344
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-3381
  • Fax:
Mailing address:
  • Phone: 336-716-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24721
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD.206716
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number24721
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: