Provider Demographics
NPI:1306039516
Name:ELIZABETH ROSS, MD & KENNETH LEE, MD PC
Entity Type:Organization
Organization Name:ELIZABETH ROSS, MD & KENNETH LEE, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-775-0955
Mailing Address - Street 1:2021 K ST NW
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-775-0955
Mailing Address - Fax:
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 315
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-775-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC611954E54Medicare PIN