Provider Demographics
NPI:1558333716
Name:SUMMER, ROSS S (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:S
Last Name:SUMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 WALNUT ST
Mailing Address - Street 2:SUITE 650
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-955-5161
Mailing Address - Fax:215-923-6003
Practice Address - Street 1:834 WALNUT ST
Practice Address - Street 2:SUITE 650
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-955-5161
Practice Address - Fax:215-923-6003
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159158207RP1001X
PAMD444745207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA01952406Medicaid
NJ0308854Medicaid
PA102731025Medicaid
MARX2010Medicare PIN
MAA33741Medicare ID - Type Unspecified
PA102731025Medicaid
MA01952406Medicaid