Provider Demographics
NPI:1508869090
Name:ROSS, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:367 W EVANS ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3429
Mailing Address - Country:US
Mailing Address - Phone:843-669-4156
Mailing Address - Fax:843-664-2121
Practice Address - Street 1:367 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3429
Practice Address - Country:US
Practice Address - Phone:843-669-4156
Practice Address - Fax:843-664-2121
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC11764207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4254796OtherAETNA
SC9624212OtherGHI
SC276873OtherPRIVATE HEALTHCARE SYSTEM
NC890602CMedicaid
SC621812OtherSELECT HEALTH
SCAT6689Medicaid
SC180012103OtherRAILROAD MEDICARE
SCS327574OtherCIGNA
SCC60166Medicare UPIN