Provider Demographics
NPI:1932105210
Name:HOUSTON, ROBERT ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROSS
Last Name:HOUSTON
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 1:715 E WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3358
Mailing Address - Country:US
Mailing Address - Phone:330-726-3204
Mailing Address - Fax:330-729-9316
Practice Address - Street 1:715 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3358
Practice Address - Country:US
Practice Address - Phone:330-726-3204
Practice Address - Fax:330-729-9316
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045380207RC0000X, 207UN0901X
PAMD017919E207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0581311Medicaid
PA0788213Medicaid
OH1932105210OtherNPI
PA1932105210OtherNPI
C01902Medicare UPIN
PA010890-S3HMedicare ID - Type Unspecified
C01902Medicare UPIN