Provider Demographics
NPI:1063168748
Name:ROSS, CHAD LAMONT
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:LAMONT
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-7100
Mailing Address - Country:US
Mailing Address - Phone:724-420-0426
Mailing Address - Fax:
Practice Address - Street 1:12 MARCUS DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7100
Practice Address - Country:US
Practice Address - Phone:724-420-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant