Healthcare Provider Details

I. General information

NPI: 1295715589
Provider Name (Legal Business Name): ALLAN ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 GREEN VALLEY RD STE 201
GREENSBORO NC
27408
US

IV. Provider business mailing address

719 GREEN VALLEY RD STE 201
GREENSBORO NC
27408
US

V. Phone/Fax

Practice location:
  • Phone: 336-378-1110
  • Fax: 336-378-9986
Mailing address:
  • Phone: 336-378-1110
  • Fax: 336-378-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberNC23328
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: