Provider Demographics
NPI:1346684735
Name:PROSS, CAROL D (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:D
Last Name:PROSS
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 1:5 FERGUSON CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9725
Mailing Address - Country:US
Mailing Address - Phone:215-378-9413
Mailing Address - Fax:
Practice Address - Street 1:5 FERGUSON CT
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9725
Practice Address - Country:US
Practice Address - Phone:215-378-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71019208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery