Provider Demographics
NPI:1518982560
Name:ROSS, BARBRA A (MD)
Entity Type:Individual
Prefix:
First Name:BARBRA
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TOYON AVE
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2459
Mailing Address - Country:US
Mailing Address - Phone:650-996-6692
Mailing Address - Fax:415-435-6943
Practice Address - Street 1:15 TOYON AVE
Practice Address - Street 2:
Practice Address - City:BELVEDERE
Practice Address - State:CA
Practice Address - Zip Code:94920-2459
Practice Address - Country:US
Practice Address - Phone:650-996-6692
Practice Address - Fax:415-435-6943
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA537022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537020Medicaid
CAA53702OtherSTATE LICENSE
CAA53702OtherSTATE LICENSE
CAG68277Medicare UPIN
CA00A537023Medicare PIN
CA00A537024Medicare PIN