Provider Demographics
NPI:1477522563
Name:ROSS, RONALD DUDLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DUDLEY
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3223
Mailing Address - Country:US
Mailing Address - Phone:215-885-6408
Mailing Address - Fax:
Practice Address - Street 1:5158 BLACK HAWK RD
Practice Address - Street 2:USA CHPPM
Practice Address - City:GUNPOWDER
Practice Address - State:MD
Practice Address - Zip Code:21010-5403
Practice Address - Country:US
Practice Address - Phone:410-436-2486
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 039110 L2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine