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1811163199

NPI Code Detail

MEDICARE: DR. ETHAN M ROSS D.O.

MEDICARE: DR. ETHAN M ROSS D.O.

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	207P00000X	Emergency Medicine Physician	C7-0004008	DE
2	207P00000X	Emergency Medicine Physician	49891	CO
3	207P00000X	Emergency Medicine Physician	2695	WI
4	207P00000X	Emergency Medicine Physician	DO3369	ME

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

General Provider Information

NPI Number	:	1811163199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHAN M ROSS D.O.

Provider Business Mailing Address
First Line	:	42 CROSS HILL RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-5116
Country	:	US
Telephone Number	:	302-757-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 STATE HIGHWAY 66
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54482-8410
Country	:	US
Telephone Number	:	715-997-6000
Fax Number	:

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

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/10/2023

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Directions to “ DR. ETHAN M ROSS D.O.” Practice Location

Language	Start Address	Practice Location

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