Provider Demographics
NPI:1194712208
Name:ROSS, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
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 1:6410 ROCKLEDGE DR STE 610
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1844
Mailing Address - Country:US
Mailing Address - Phone:301-530-9745
Mailing Address - Fax:301-530-0046
Practice Address - Street 1:6410 ROCKLEDGE DR STE 610
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1844
Practice Address - Country:US
Practice Address - Phone:301-530-9745
Practice Address - Fax:301-530-0046
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH104012084N0400X, 2084N0600X
MDD832442084N0400X
MA798972084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0101564Y0MA01OtherANTHEM
MA0012343OtherNHP
MA05-00403OtherEVERCARE
NJ30011684Medicaid
MA35979OtherFCHP
MA7262069OtherAETNA
MA11934OtherHPHC
MA3629452-001OtherCIGNA
MD122760200Medicaid
MA079897OtherTHP
MA05-00217OtherUHC
MAJ17998OtherBCBS
MA3180182Medicaid
NH0101564Y0MA01OtherANTHEM
MA05-00403OtherEVERCARE