Provider Demographics
NPI:1982734000
Name:ROSS, HARRIS A (DO)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:A
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W GODFREY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120
Mailing Address - Country:US
Mailing Address - Phone:215-276-1122
Mailing Address - Fax:215-549-4007
Practice Address - Street 1:328 W GODFREY AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120
Practice Address - Country:US
Practice Address - Phone:215-276-1122
Practice Address - Fax:215-549-4007
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002098L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
118986800OtherDOL
0547727000OtherKEYSTONE
D66312Medicare UPIN
087096Medicare ID - Type Unspecified