Provider Demographics
NPI:1477653988
Name:ROSS, PAMELA D (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:12 ST PAUL DR STE 104
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1035
Practice Address - Country:US
Practice Address - Phone:717-263-8463
Practice Address - Fax:717-263-1103
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052608363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1716306OtherINTERGROUP
PA25-1716306OtherGREATWEST
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherMULTIPLAN/PHCS
PA50081917OtherCAPITAL BLUECROSS
PAMA052608OtherLICENSE
PAP00708427OtherRAILROAD MEDICARE
PA120420421OtherDEPT OF LABOR
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherDEVON
PA103146422Medicaid
PA103146422Medicaid