Provider Demographics
NPI:1629743901
Name:ROSS, ERIC MICHAEL (CRNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:ROSS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PENN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-3224
Mailing Address - Country:US
Mailing Address - Phone:412-442-2343
Mailing Address - Fax:412-325-2536
Practice Address - Street 1:501 PENN AVE STE 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-3224
Practice Address - Country:US
Practice Address - Phone:412-442-2343
Practice Address - Fax:412-325-2536
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103999500Medicaid
15425935OtherCAQH