Provider Demographics
NPI:1518187822
Name:ROSS, KARLENE VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLENE
Middle Name:VANESSA
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3460 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3240
Mailing Address - Country:US
Mailing Address - Phone:301-638-0001
Mailing Address - Fax:301-638-5454
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE #103
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-638-0001
Practice Address - Fax:301-638-5454
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2008-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY214300207Q00000X
MDD0066434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH49353Medicare UPIN