Provider Demographics
NPI:1962466201
Name:ROSS, LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1578 WILLIAMSBRIDGE RD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6265
Mailing Address - Country:US
Mailing Address - Phone:718-863-8465
Mailing Address - Fax:718-863-8983
Practice Address - Street 1:1578 WILLIAMSBRIDGE RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6265
Practice Address - Country:US
Practice Address - Phone:718-863-8465
Practice Address - Fax:718-863-8983
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY118150207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00248935Medicaid
NYA400016990OtherINDIVIDUAL PTAN
NYC08337Medicare UPIN