Provider Demographics
NPI:1952458820
Name:ROSS, DEBORAH ROSALIE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ROSALIE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5034
Practice Address - Country:US
Practice Address - Phone:336-349-4454
Practice Address - Fax:336-349-5186
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC331272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC73427OtherBCBSNC
NC8973427Medicaid
NC8973427Medicaid
NCF34884Medicare UPIN