Provider Demographics
NPI:1013956796
Name:ROSS, LAWRENCE I (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:I
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:396 ROUTE 6 AND 209
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9490
Mailing Address - Country:US
Mailing Address - Phone:570-296-9696
Mailing Address - Fax:570-409-0316
Practice Address - Street 1:225 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2922
Practice Address - Country:US
Practice Address - Phone:516-364-5400
Practice Address - Fax:516-677-3653
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2019-08-06
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Provider Licenses
StateLicense IDTaxonomies
NY220613207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH41916Medicare UPIN
NY9255RFMedicare ID - Type Unspecified