MEDICARE: DR. KATHRYN 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	207RG0100X	Gastroenterology Physician	G42979	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	WG42979B	OTHER		MEDICARE PTAN

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	:	1871537035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN A ROSS M.D.

Provider Business Mailing Address
First Line	:	901 DOVER DR
Second Line	:	SUITE 122
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5538
Country	:	US
Telephone Number	:	949-650-8700
Fax Number	:	949-650-0877

Provider Business Practice Location Address
First Line	:	901 DOVER DR
Second Line	:	SUITE 122
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5538
Country	:	US
Telephone Number	:	949-650-8700
Fax Number	:	949-650-0877

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/10/2011

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Directions to “ DR. KATHRYN A ROSS M.D.” Practice Location

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