Provider Demographics
NPI:1780678490
Name:ROSS, JOHNATHON S (MD)
Entity Type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:S
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43624-1120
Mailing Address - Country:US
Mailing Address - Phone:419-251-2673
Mailing Address - Fax:419-251-0916
Practice Address - Street 1:2409 CHERRY ST
Practice Address - Street 2:SUITE 207
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2625
Practice Address - Country:US
Practice Address - Phone:419-251-4696
Practice Address - Fax:419-251-3572
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35045022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0428684Medicaid
OHRO0484876Medicare PIN
D31207Medicare UPIN