MEDICARE: DR. PETER A. 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	2085R0202X	Diagnostic Radiology Physician	144136-1	NY

General Provider Information

NPI Number	:	1649506015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A. ROSS M.D.

Provider Business Mailing Address
First Line	:	500 E 77TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10162-0025
Country	:	US
Telephone Number	:	212-650-9772
Fax Number	:	212-650-9772

Provider Business Practice Location Address
First Line	:	500 E 77TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10162-0025
Country	:	US
Telephone Number	:	212-650-9772
Fax Number	:	212-650-9772

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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