Provider Demographics
NPI:1801862149
Name:ROSS, PAUL B (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:ROSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8218 WISCONSIN AVE STE P14
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3138
Mailing Address - Country:US
Mailing Address - Phone:301-656-6055
Mailing Address - Fax:301-656-6058
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:SUITE P-14
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-656-6055
Practice Address - Fax:301-656-6058
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000458213ES0103X
MD00578213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D30296Medicare UPIN
031670Medicare ID - Type Unspecified