MEDICARE: DR. JONATHAN 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	2084N0400X	Neurology Physician	10401	NH
2	2084N0400X	Neurology Physician	D83244	MD
3	2084N0400X	Neurology Physician	79897	MA
4	2084N0600X	Clinical Neurophysiology Physician	79897	MA
5	2084N0600X	Clinical Neurophysiology Physician	10401	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101564Y0MA01	OTHER	NH	ANTHEM
2	0012343	OTHER	MA	NHP
3	05-00403	OTHER	MA	EVERCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	35979	OTHER	MA	FCHP
6	7262069	OTHER	MA	AETNA
7	11934	OTHER	MA	HPHC
8	3629452-001	OTHER	MA	CIGNA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	079897	OTHER	MA	THP
11	05-00217	OTHER	MA	UHC
12	J17998	OTHER	MA	BCBS
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194712208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN ROSS M.D.

Provider Business Mailing Address
First Line	:	6410 ROCKLEDGE DR STE 610
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-1844
Country	:	US
Telephone Number	:	301-530-9745
Fax Number	:	301-530-0046

Provider Business Practice Location Address
First Line	:	6410 ROCKLEDGE DR STE 610
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-1844
Country	:	US
Telephone Number	:	301-530-9745
Fax Number	:	301-530-0046

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	04/14/2021

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