Healthcare Provider Details

I. General information

NPI: 1588614861
Provider Name (Legal Business Name): ASTHMA AND ALLERGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 OLD MILL CIR SUITE A
WINSTON SALEM NC
27103-2973
US

IV. Provider business mailing address

1401 OLD MILL CIR SUITE A
WINSTON SALEM NC
27103-2973
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-0914
  • Fax: 336-760-1896
Mailing address:
  • Phone: 336-768-0914
  • Fax: 336-760-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT MITCHELL ROSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 336-768-0914