Provider Demographics
NPI:1588614861
Name:ASTHMA AND ALLERGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ASTHMA AND ALLERGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-768-0914
Mailing Address - Street 1:1401 OLD MILL CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2973
Mailing Address - Country:US
Mailing Address - Phone:336-768-0914
Mailing Address - Fax:336-760-1896
Practice Address - Street 1:1401 OLD MILL CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2973
Practice Address - Country:US
Practice Address - Phone:336-768-0914
Practice Address - Fax:336-760-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891026YMedicaid
NC2319157Medicare ID - Type Unspecified
NCC81258Medicare UPIN