Basic Information
| Provider Information | |||||||||
| NPI: | 1477653988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 ST PAUL DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172638463 | ||||||||
| FaxNumber: | 7172631103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 12/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA052608 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 25-1716306 | 01 | PA | GREATWEST | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | MR1880651 | 01 | PA | DEA | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 50081917 | 01 | PA | CAPITAL BLUECROSS | OTHER | MA052608 | 01 | PA | LICENSE | OTHER | P00708427 | 01 | PA | RAILROAD MEDICARE | OTHER | 120420421 | 01 | PA | DEPT OF LABOR | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 103146422 | 05 | PA | MEDICAID |