Provider Demographics
NPI:1780904276
Name:RISMILLER, ROSS WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:WILLIAM
Last Name:RISMILLER
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 1:7 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-4022
Mailing Address - Country:US
Mailing Address - Phone:570-622-1536
Mailing Address - Fax:
Practice Address - Street 1:7 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-4022
Practice Address - Country:US
Practice Address - Phone:570-622-1536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008150-E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology