Provider Demographics
NPI:1083707244
Name:ROSS, RANDY B (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:B
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 1:9 HORSESHOE HILL RD W
Mailing Address - Street 2:
Mailing Address - City:POUND RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10576-1615
Mailing Address - Country:US
Mailing Address - Phone:718-409-8866
Mailing Address - Fax:718-597-3351
Practice Address - Street 1:MMG - BRONX EAST
Practice Address - Street 2:2300 WESTCHESTER AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-409-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine