Provider Demographics
NPI:1609876994
Name:ROSS, DANIEL I (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:I
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1739 W FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3189
Mailing Address - Country:US
Mailing Address - Phone:610-437-4988
Mailing Address - Fax:610-437-4176
Practice Address - Street 1:1739 W FAIRMONT ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-3189
Practice Address - Country:US
Practice Address - Phone:610-437-4988
Practice Address - Fax:610-437-4176
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD036147E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011667460003Medicaid
PA177758HUPMedicare PIN
PA0011667460003Medicaid
PAB76640Medicare UPIN