Provider Demographics
NPI:1932105632
Name:ROSS, SHANNAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNAN
Middle Name:C
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 1:3780 MEDINA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9312
Mailing Address - Country:US
Mailing Address - Phone:330-723-6060
Mailing Address - Fax:330-723-6462
Practice Address - Street 1:3780 MEDINA RD STE 220
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9312
Practice Address - Country:US
Practice Address - Phone:330-723-6060
Practice Address - Fax:330-723-6462
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082532R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7349474OtherAETNA
OH000000298482OtherANTHEM
OH2401814Medicaid
OH000000298482OtherANTHEM
H84301Medicare UPIN