Provider Demographics
NPI:1477655025
Name:ROSS, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
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 1:755 MAIN ST
Mailing Address - Street 2:BUILDING 4, SUITE B
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:755 MAIN ST
Practice Address - Street 2:BUILDING 4, SUITE B
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2830
Practice Address - Country:US
Practice Address - Phone:203-268-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0294352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE43480Medicare UPIN