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NPI Code Detail

MEDICARE: DR. ROBERT GARY ROSS ED. D.

MEDICARE:  DR. ROBERT GARY ROSS  ED. 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
1103T00000XPsychologist3540MA

General Provider Information

NPI Number : 1477694099
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT GARY ROSS ED. D.
Provider Business Mailing Address
First Line : 17 BRADFORD ST
Second Line :
City : BOSTON
State : MA
Zip : 02118-2118
Country : US
Telephone Number : 617-426-1920
Fax Number :
Provider Business Practice Location Address
First Line : 17 BRADFORD ST
Second Line :
City : BOSTON
State : MA
Zip : 02118-2118
Country : US
Telephone Number : 617-426-1920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 07/08/2007

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Directions to “ DR. ROBERT GARY ROSS ED. D.” Practice Location

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