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1811916463 NPI number — ROBERT RICHARD ROSS PA-C

NPI Number: 1811916463
Health Care Provider/Practitioner: ROBERT RICHARD ROSS PA-C

Information about “1811916463” NPI (ROBERT RICHARD ROSS PA-C) exists in 1811916463 in HTML format HTML  |  1811916463 in plain Text format TXT  |  1811916463 in PDF (Portable Document Format) PDF  |  1811916463 in an XML format XML  formats.

NPI Number : 1811916463 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811916463",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROSS",
    "FirstName": "ROBERT",
    "MiddleName": "RICHARD",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "NORTHERN LIGHT EASTERN MAINE MEDICAL CENTER-EMERGENCY C",
    "SecondLineMailingAddress": "489 STATE STREET",
    "MailingAddressCityName": "BANGOR",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04401",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-973-8000",
    "MailingAddressFaxNumber": "207-273-7985",
    "FirstLinePracticeLocationAddress": "2000 GREEN RD.",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "ANN ARBOR",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48105",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "374-995-3764",
    "PracticeLocationAddressFaxNumber": "208-475-9028",
    "EnumerationDate": "07/18/2006",
    "LastUpdateDate": "08/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "06/22/2025",
    "NPIReactivationDate": "08/06/2025",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA2870",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "5601001593",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PA2870",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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