Provider Demographics
NPI:1245226315
Name:ROSS, JUDY D (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:D
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:D
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1050 BOWER HILL RD
Mailing Address - Street 2:205
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1800
Mailing Address - Country:US
Mailing Address - Phone:412-572-6184
Mailing Address - Fax:412-572-6586
Practice Address - Street 1:1050 BOWER HILL RD
Practice Address - Street 2:205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1800
Practice Address - Country:US
Practice Address - Phone:412-572-6184
Practice Address - Fax:412-572-6586
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018645520001Medicaid
PA053571Medicare ID - Type Unspecified
PA0018645520001Medicaid