Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 002466 | NY |
Y | 213ES0000X | Sports Medicine | 002466 | NY |
NPI | 1538163373 |
---|---|
Provider Name | Dr. Charles F Ross |
First Address | Leeds, MA 01053-9764 |
Second Address | Pittsfield, MA 01201-7463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 03/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T50767 | (02) | MA |
Y78071 | (02) | MA |