MEDICARE: DR. MARK S ROSS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC002100L	PA

General Provider Information

NPI Number	:	1285630152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK S ROSS DPM

Provider Business Mailing Address
First Line	:	301 OXFORD VALLEY RD
Second Line	:	STE 1106A
City	:	YARDLEY
State	:	PA
Zip	:	19067-7718
Country	:	US
Telephone Number	:	215-493-0222
Fax Number	:	215-493-7662

Provider Business Practice Location Address
First Line	:	301 OXFORD VALLEY RD
Second Line	:	STE 1106A
City	:	YARDLEY
State	:	PA
Zip	:	19067-7718
Country	:	US
Telephone Number	:	215-493-0222
Fax Number	:	215-493-7662

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	12/15/2011

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