Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 036137677 | IL |
Y | 207VX0201X | Gynecologic Oncologist | 84828 | SC |
NPI | 1275829616 |
---|---|
Provider Name | Dr. Jerlinda Gladys Camille Ross |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 03/02/2021 |