Provider Demographics
NPI:1124184841
Name:ZELESNICK, ROSS P (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:P
Last Name:ZELESNICK
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 1:3849 FAIRWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1349
Mailing Address - Country:US
Mailing Address - Phone:443-789-2953
Mailing Address - Fax:
Practice Address - Street 1:125 AIRPORT DR
Practice Address - Street 2:SUITE 34
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3024
Practice Address - Country:US
Practice Address - Phone:410-848-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant