Provider Demographics
NPI:1720160484
Name:ROSS, LAURENCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:H
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6535 N CHARLES ST
Mailing Address - Street 2:SUTIE 510
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5826
Mailing Address - Country:US
Mailing Address - Phone:410-821-6260
Mailing Address - Fax:410-296-6936
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:SUTIE 510
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:410-821-6260
Practice Address - Fax:410-296-6936
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0035727208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420084-01OtherCARE 1ST BCBS
MD278721100Medicaid
MDR055Medicare PIN
MD420084-01OtherCARE 1ST BCBS