MEDICARE: DR. JEROME ROSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	D0009835	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36069	OTHER	MD	MAMSI
2	452862	OTHER	MD	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5322-0001	OTHER	MD	BLUE CHOICE

General Provider Information

NPI Number	:	1093711418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME ROSS M.D.

Provider Business Mailing Address
First Line	:	1001 PINE HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5208
Country	:	US
Telephone Number	:	410-644-9515
Fax Number	:	410-644-8250

Provider Business Practice Location Address
First Line	:	1001 PINE HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5208
Country	:	US
Telephone Number	:	410-644-9515
Fax Number	:	410-644-8250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/05/2011

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