Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | MD022041E | PA |
NPI | 1316022494 |
---|---|
Provider Name | Dr. Judith L. Ross |
First Address | Atlanta, GA 30384-0001 |
Second Address | Philadelphia, PA 19107-4413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 30/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000911442 | (05) | PA |
0226203 | (05) | NJ |
1277049 | (05) | MD |
E64403 | (02) |