Provider Demographics
NPI:1316022494
Name:ROSS, JUDITH L (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:L
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:NEMOURS CHILDRENS CLINIC
Mailing Address - Street 2:P.O. BOX 404112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:DUPONT AT JEFFERSON
Practice Address - Street 2:833 CHESTNUT STREET EAST SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4413
Practice Address - Country:US
Practice Address - Phone:215-955-5800
Practice Address - Fax:215-923-4267
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022041E2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1277049Medicaid
PA000911442Medicaid
NJ0226203Medicaid
MD1277049Medicaid
PA000911442Medicaid