Healthcare Provider Details

I. General information

NPI: 1740105956
Provider Name (Legal Business Name): GERAYE C ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 43RD ST
PHILADELPHIA PA
19104-4418
US

IV. Provider business mailing address

1802 LOYALSOCK DR UNIT 3
WILLIAMSPORT PA
17701-2972
US

V. Phone/Fax

Practice location:
  • Phone: 610-660-1000
  • Fax:
Mailing address:
  • Phone: 570-916-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: