Provider Demographics
NPI:1104931328
Name:SIMMONS, MICHAEL ROSS (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROSS
Last Name:SIMMONS
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 1:57 W TIMONIUM RD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3125
Mailing Address - Country:US
Mailing Address - Phone:410-252-6400
Mailing Address - Fax:410-252-6402
Practice Address - Street 1:57 W TIMONIUM RD
Practice Address - Street 2:SUITE #208
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3125
Practice Address - Country:US
Practice Address - Phone:410-252-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30190207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7588Medicare ID - Type Unspecified
D76590Medicare UPIN