Healthcare Provider Details

I. General information

NPI: 1497843924
Provider Name (Legal Business Name): MARTIN ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E CHESTNUT ST STE 106
ROME NY
13440-2834
US

IV. Provider business mailing address

PO BOX 2000
EAST SYRACUSE NY
13057-4500
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-3200
  • Fax: 315-338-9202
Mailing address:
  • Phone: 315-362-5129
  • Fax: 315-362-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD449381
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number029940
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number165771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: