Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 30323 | SC |
NPI | 1164413563 |
---|---|
Provider Name | Dr. Scott D Ross |
First Address | Charlotte, NC 28275-1649 |
Second Address | Charleston, SC 29401-1113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
303237 | (05) | SC |
I41739 | (02) | SC |
P00615369 | RAILROAD MEDICARE (01) | SC |
P00832518 | RAILROAD MEDICARE ID-RSFPN (01) | SC |