Provider Demographics
NPI:1336462803
Name:MARTIN ROSS MD PC
Entity Type:Organization
Organization Name:MARTIN ROSS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-831-0000
Mailing Address - Street 1:148 EAST AVE STE 2N
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5727
Mailing Address - Country:US
Mailing Address - Phone:203-831-0000
Mailing Address - Fax:203-866-3622
Practice Address - Street 1:148 EAST AVE STE 2N
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5727
Practice Address - Country:US
Practice Address - Phone:203-831-0000
Practice Address - Fax:203-866-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty