Basic Information
Provider Information | |||||||||
NPI: | 1265593396 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROSS | ||||||||
FirstName: | MITCHELL | ||||||||
MiddleName: | NEAL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2101 EAST JEFFERSON STREET | ||||||||
Address2: | MEDICARE COMPLIANCE UNIT 6 WEST | ||||||||
City: | ROCKVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 208524908 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3018166464 | ||||||||
FaxNumber: | 3018166308 | ||||||||
Practice Location | |||||||||
Address1: | 10810 CONNECTICUT AVENUE | ||||||||
Address2: |   | ||||||||
City: | KENSINGTON | ||||||||
State: | MD | ||||||||
PostalCode: | 208952138 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019297100 | ||||||||
FaxNumber: | 3019297022 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/13/2006 | ||||||||
LastUpdateDate: | 11/10/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D0039061 | MD | Y |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 0101044526 | VA | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | MD18753 | DC | N |   | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.