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NPI Code Detail

MEDICARE: ELLEN ROSS PA-C

MEDICARE: ELLEN ROSS PA-C
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
1363A00000XPhysician Assistant0317PNH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00100698OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15830418OTHERAETNA GROUP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
40317POTHERNHSTATE LICENSE #
50109410YPNH02OTHERNHANTHEM BC/BS
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972505733
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN ROSS PA-C
Provider Business Mailing Address
First Line : 133 PLEASANT ST
Second Line :
City : BERLIN
State : NH
Zip : 03570-2006
Country : US
Telephone Number : 603-752-2040
Fax Number : 603-752-1709
Provider Business Practice Location Address
First Line : 59 PAGE HILL RD
Second Line :
City : BERLIN
State : NH
Zip : 03570-3531
Country : US
Telephone Number : 603-752-2900
Fax Number : 603-752-3727
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 03/07/2023

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Directions to “ ELLEN ROSS PA-C” Practice Location

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