Provider Demographics
NPI:1295835833
Name:ROSS-MCCORMACK, RUTH A (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:ROSS-MCCORMACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LAHEY CLINIC
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-764-1010
Mailing Address - Fax:781-744-7132
Practice Address - Street 1:37 BROADWAY
Practice Address - Street 2:LAHEY ARLINGTON
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-5552
Practice Address - Country:US
Practice Address - Phone:781-641-0100
Practice Address - Fax:781-744-7132
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA77649207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3141161Medicaid
MAA2073501Medicare PIN
MA3141161Medicaid