Provider Demographics
NPI:1982643607
Name:ROSS, MICHAEL LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEONARD
Last Name:ROSS
Suffix:
Gender:M
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:PO BOX 19368
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-9368
Mailing Address - Country:US
Mailing Address - Phone:919-787-8221
Mailing Address - Fax:919-789-4461
Practice Address - Street 1:3949 BROWNING PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6504
Practice Address - Country:US
Practice Address - Phone:919-787-8221
Practice Address - Fax:919-789-4461
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC260462085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC63136OtherMEDCOST
NC8973311Medicaid
NC16-54664OtherUNITED HEALTHCARE
NC16-54665OtherUNITED HEALTHCARE
NC63165OtherMEDCOST
NC73311OtherBLUECROSS BLUESHIELD
NC16-54663OtherUNITED HEALTHCARE
NC63193OtherMEDCOST
NC63165OtherMEDCOST
NC16-54663OtherUNITED HEALTHCARE
NC73311OtherBLUECROSS BLUESHIELD
B49224Medicare UPIN