=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033113998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ROSS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 11/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 WHITE HORSE RD STE D105
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-435-1777
-----------------------------------------------------
Fax | 856-435-7291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 WHITE HORSE RD STE D105
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-435-1777
-----------------------------------------------------
Fax | 856-435-7291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MA02910500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------