Provider Demographics
NPI:1528034279
Name:ROSS, KRISTINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 633698
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3698
Mailing Address - Country:US
Mailing Address - Phone:513-244-9007
Mailing Address - Fax:513-686-5443
Practice Address - Street 1:4777 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2725
Practice Address - Country:US
Practice Address - Phone:513-244-9070
Practice Address - Fax:513-686-5443
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35083897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64015324Medicaid
OH2270920Medicaid
IN200178900Medicaid
KY64015324Medicaid
OH2270920Medicaid