Provider Demographics
NPI:1346315959
Name:ROSS, CONNIE GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:GENE
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:PO BOX 1521
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-8392
Mailing Address - Country:US
Mailing Address - Phone:828-287-5867
Mailing Address - Fax:828-859-0422
Practice Address - Street 1:590 S TRADE ST
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-3714
Practice Address - Country:US
Practice Address - Phone:828-859-0420
Practice Address - Fax:828-859-0422
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12833208D00000X
NC32565208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C82359Medicare UPIN