Healthcare Provider Details

I. General information

NPI: 1205802774
Provider Name (Legal Business Name): DIANA L ROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7665 MONARCH CT STE 101
WEST CHESTER OH
45069-2497
US

IV. Provider business mailing address

7665 MONARCH CT STE 101
WEST CHESTER OH
45069-2497
US

V. Phone/Fax

Practice location:
  • Phone: 513-942-6938
  • Fax: 513-777-0431
Mailing address:
  • Phone: 513-942-6938
  • Fax: 513-777-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35-043740
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: