MEDICARE: ROSS J VANANTWERP D.O., M.P.H.

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	207R00000X	Internal Medicine Physician	H0033830	MD

General Provider Information

NPI Number	:	1790924512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSS J VANANTWERP D.O., M.P.H.

Provider Business Mailing Address
First Line	:	484 RITCHIE HWY STE A
Second Line	:
City	:	SEVERNA PARK
State	:	MD
Zip	:	21146-2961
Country	:	US
Telephone Number	:	410-544-4600
Fax Number	:	410-544-0997

Provider Business Practice Location Address
First Line	:	1 PARK PLACE STE 325
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3475
Country	:	US
Telephone Number	:	410-995-8550
Fax Number	:	410-514-3582

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

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	10/23/2024

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