Provider Demographics
NPI:1881694289
Name:ROSS, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ROSS
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 1:501 VAN BUREN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1593
Mailing Address - Country:US
Mailing Address - Phone:419-435-4950
Mailing Address - Fax:419-435-0849
Practice Address - Street 1:501 VAN BUREN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1593
Practice Address - Country:US
Practice Address - Phone:419-435-4950
Practice Address - Fax:419-435-0849
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064459207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH14-10282OtherUHC
OH282548894-009OtherMMOH
OH4557221OtherAETNA
OH01984OtherPARAMOUNT
OH0914032Medicaid
OH000000295676OtherANTHEM
OH160060037OtherRRMC
OHC74983Medicare UPIN
OH000000295676OtherANTHEM