Provider Demographics
NPI:1609918283
Name:CHARLES F. ROSS, DPM, PC
Entity Type:Organization
Organization Name:CHARLES F. ROSS, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FREDEDRICK
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:413-443-2468
Mailing Address - Street 1:10 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6204
Mailing Address - Country:US
Mailing Address - Phone:413-443-2468
Mailing Address - Fax:413-499-2768
Practice Address - Street 1:10 2ND ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6204
Practice Address - Country:US
Practice Address - Phone:413-443-2468
Practice Address - Fax:413-499-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1845213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00414686Medicaid
MA0310824Medicaid
MA0310824Medicaid
MAY49992Medicare UPIN
MAY78071Medicare ID - Type Unspecified