Provider Demographics
NPI:1649457235
Name:WANK, ROSS IRA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:IRA
Last Name:WANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1411 WALNUT ST
Mailing Address - Street 2:APARTMENT 403
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3129
Mailing Address - Country:US
Mailing Address - Phone:917-301-1737
Mailing Address - Fax:
Practice Address - Street 1:132 S. 10TH STREET
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY 1087 MAIN BLDG.
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5244
Practice Address - Country:US
Practice Address - Phone:917-301-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1917222085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging