Provider Demographics
NPI:1508833963
Name:ROSS, MARTIN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:PAUL
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:PAUL
Other - Last Name:SIEG-ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4744 41ST AVE SW
Mailing Address - Street 2:STE 102
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116
Mailing Address - Country:US
Mailing Address - Phone:206-932-0880
Mailing Address - Fax:206-932-3738
Practice Address - Street 1:4744 41ST AVE SW
Practice Address - Street 2:STE 102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-932-0880
Practice Address - Fax:206-932-3738
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00211319OtherRAILROAD MEDICARE
WA0174746OtherL & I
WA1109370Medicaid
WA0174746OtherL & I
WAP00211319OtherRAILROAD MEDICARE