Provider Demographics
NPI:1144596156
Name:ROSS, CAROLYN MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MICHELLE
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 1:1 FEDERAL ST STE SW200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:1900 BURLINGTON MOUNT HOLLY RD STE D
Practice Address - Street 2:
Practice Address - City:BURLINGTON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08016-4722
Practice Address - Country:US
Practice Address - Phone:609-835-5570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140308207V00000X
NJ25MA10357100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology