Provider Demographics
NPI:1023043429
Name:WORTHINGTON, ROSS A (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:A
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8901 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2477
Mailing Address - Country:US
Mailing Address - Phone:414-328-7950
Mailing Address - Fax:414-328-8505
Practice Address - Street 1:2629 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4932
Practice Address - Country:US
Practice Address - Phone:920-451-5542
Practice Address - Fax:920-451-5544
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI45231207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H85833Medicare UPIN