Provider Demographics
NPI:1922103332
Name:ROSS, ELIZABETH KATRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KATRINA
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 MERIDIAN
Mailing Address - Street 2:STE 200
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-676-1470
Mailing Address - Fax:360-676-0377
Practice Address - Street 1:3614 MERIDIAN
Practice Address - Street 2:STE 200
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-676-1470
Practice Address - Fax:360-676-0377
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A41545Medicare UPIN
8854093Medicare ID - Type Unspecified