Provider Demographics
NPI:1972675353
Name:ROSS, DONALD L (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:45 MAIN ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1000
Mailing Address - Country:US
Mailing Address - Phone:866-662-4560
Mailing Address - Fax:877-279-9425
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1000
Practice Address - Country:US
Practice Address - Phone:866-662-4560
Practice Address - Fax:877-279-9425
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-09-30
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Provider Licenses
StateLicense IDTaxonomies
NY170990207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01839523Medicaid
NY01839523Medicaid
D82510Medicare UPIN