Provider Demographics
NPI:1285630152
Name:ROSS, MARK S (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:ROSS
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:301 OXFORD VALLEY RD
Mailing Address - Street 2:STE 1106A
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7718
Mailing Address - Country:US
Mailing Address - Phone:215-493-0222
Mailing Address - Fax:215-493-7662
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:STE 1106A
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7718
Practice Address - Country:US
Practice Address - Phone:215-493-0222
Practice Address - Fax:215-493-7662
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-12-15
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Provider Licenses
StateLicense IDTaxonomies
PASC002100L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28348Medicare UPIN
PA036563Medicare PIN
PA5359790001Medicare NSC