Provider Demographics
NPI:1861447666
Name:ROSS, DOUGLAS DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DONALD
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:PO BOX 62602
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2602
Mailing Address - Country:US
Mailing Address - Phone:410-328-3685
Mailing Address - Fax:410-328-6559
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3685
Practice Address - Fax:410-328-6559
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026327207RH0003X
MDD26327207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD34954501OtherBLUE CROSS/BLUE SHIELD
MD340171500Medicaid
MD349L807BMedicare PIN
MD409019ZAQPMedicare PIN
MD340171500Medicaid