MEDICARE: BARBRA A ROSS MD

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	2085R0202X	Diagnostic Radiology Physician	A53702	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A53702	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1518982560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBRA A ROSS MD

Provider Business Mailing Address
First Line	:	15 TOYON AVE
Second Line	:
City	:	BELVEDERE
State	:	CA
Zip	:	94920-2459
Country	:	US
Telephone Number	:	650-996-6692
Fax Number	:	415-435-6943

Provider Business Practice Location Address
First Line	:	15 TOYON AVE
Second Line	:
City	:	BELVEDERE
State	:	CA
Zip	:	94920-2459
Country	:	US
Telephone Number	:	650-996-6692
Fax Number	:	415-435-6943

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/31/2008

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