Provider Demographics
NPI:1003891631
Name:ROSS, MARNIE LASHAE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:LASHAE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 CALLAGHAN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1125
Mailing Address - Country:US
Mailing Address - Phone:210-314-0527
Mailing Address - Fax:
Practice Address - Street 1:5835 CALLAGHAN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1125
Practice Address - Country:US
Practice Address - Phone:210-314-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0471815-02Medicaid
TX0471815-02Medicaid
TXG06740Medicare UPIN