Provider Demographics
NPI:1154311926
Name:ROSS, TERENCE CONRAD (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:CONRAD
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N EAGLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1805
Mailing Address - Country:US
Mailing Address - Phone:859-258-5300
Mailing Address - Fax:859-258-5357
Practice Address - Street 1:100 N EAGLE CREEK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-258-5300
Practice Address - Fax:859-258-5357
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090841207RI0011X, 207RC0000X, 207RC0001X
KY26543207RI0011X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
060064447OtherRR MEDICARE
OH0802215Medicaid
WV0085877000Medicaid
KY64265432Medicaid
KYP00652896Medicare PIN
OHP00680107Medicare PIN
KYP01312563Medicare PIN
060064447OtherRR MEDICARE
WV0085877000Medicaid
KY110234213Medicare PIN
OH0802215Medicaid
OHH268570Medicare PIN
E08309Medicare UPIN
KY64265432Medicaid
WV4067221Medicare PIN
OHP01394104Medicare PIN
KY0257212Medicare PIN
OH4227052Medicare PIN
OH4227051Medicare PIN