Provider Demographics
NPI:1376525782
Name:ROSS, LEORAH H (MD)
Entity Type:Individual
Prefix:DR
First Name:LEORAH
Middle Name:H
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 1:100 LANDSDOWNE ST
Mailing Address - Street 2:APT 609
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4203
Mailing Address - Country:US
Mailing Address - Phone:617-494-6030
Mailing Address - Fax:
Practice Address - Street 1:100 LANDSDOWNE ST
Practice Address - Street 2:APT 609
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4203
Practice Address - Country:US
Practice Address - Phone:617-494-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224120207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2103028Medicaid
MARO A38359Medicare ID - Type Unspecified
MA2103028Medicaid