Provider Demographics
NPI:1659348043
Name:ROSS, ROBERT WATERS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WATERS
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:D1230
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-3237
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:D1230
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216832207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28701OtherMASSACHUSETTS BLUE CROSS
0117126OtherCIGNA
213832OtherTUFTS
AA38911OtherHPHC DFCI ONLY
MA2104261Medicaid
0117126OtherCIGNA
MAJ28701OtherMASSACHUSETTS BLUE CROSS