Provider Demographics
NPI:1114905817
Name:FICHTHORN, ROSS H (PA C)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:H
Last Name:FICHTHORN
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7173 BARNVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BERNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19506
Mailing Address - Country:US
Mailing Address - Phone:610-488-6291
Mailing Address - Fax:610-488-0534
Practice Address - Street 1:7173 BARNVILLE RD
Practice Address - Street 2:
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506
Practice Address - Country:US
Practice Address - Phone:610-488-6291
Practice Address - Fax:610-488-0534
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000137L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004424H22Medicare ID - Type Unspecified
S47917Medicare UPIN