Provider Demographics
NPI:1609832989
Name:ROSS, MICHAEL JAY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2014 WASHINGTON ST
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1607
Mailing Address - Country:US
Mailing Address - Phone:617-243-6140
Mailing Address - Fax:617-243-5809
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-6140
Practice Address - Fax:617-243-5809
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA54450207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA054450OtherTUFTS HEALTH PLAN POS
MA000000021384OtherBOSTON CITY HEALTH NET
MA803550OtherSECURE HORIZENS
MA3004015Medicaid
MA34280OtherHPHC
MA34280OtherHPHC FIRST SENIORITY
MA220017017OtherMEDICARE RR
MAB76805Medicare UPIN
MAJ07098Medicare PIN