Provider Demographics
NPI:1609263797
Name:ROSS, NICHOLAS ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 740
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4409
Mailing Address - Country:US
Mailing Address - Phone:215-955-4947
Mailing Address - Fax:215-503-3333
Practice Address - Street 1:833 CHESTNUT ST STE 740
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4409
Practice Address - Country:US
Practice Address - Phone:215-955-4947
Practice Address - Fax:215-503-3333
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD468023207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology