Provider Demographics
NPI:1710143946
Name:ROSS, SAMUEL LEE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LEE
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1558
Mailing Address - Country:US
Mailing Address - Phone:410-362-3011
Mailing Address - Fax:410-362-3037
Practice Address - Street 1:2000 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1558
Practice Address - Country:US
Practice Address - Phone:410-362-3011
Practice Address - Fax:410-362-3037
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine