Provider Demographics
NPI:1881659159
Name:ROSS, DENISE GUINN (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:GUINN
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CECILY
Other - Middle Name:DENISE
Other - Last Name:GUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-3799
Mailing Address - Fax:757-388-3221
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3799
Practice Address - Fax:757-388-3221
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025957207ZB0001X, 207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00060977OtherRAILROAD MEDICARE
VA1881659159Medicaid
NC8906047Medicaid
NC8906047OtherBLUE CROSS BLUE SHIELD
VA65725OtherSENTARA
VA01373OtherPRIORITY
VA270756OtherMPIPA OPTIMA CHOICE ALLIA
VA270756OtherMPIPA OPTIMA CHOICE ALLIA
C47204Medicare UPIN