Provider Demographics
NPI:1477529212
Name:ROSS, RAYMOND THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:THOMAS
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:930 SOUTH AVE
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3621
Mailing Address - Country:US
Mailing Address - Phone:804-524-2294
Mailing Address - Fax:804-524-0016
Practice Address - Street 1:930 SOUTH AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3621
Practice Address - Country:US
Practice Address - Phone:804-524-2294
Practice Address - Fax:804-524-0016
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038388208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA027707OtherANTHEM BCBS
VA007385382Medicaid
VA007385382Medicaid
020000204Medicare PIN
VAD73310Medicare UPIN
020000204Medicare PIN