Provider Demographics
NPI:1285692392
Name:ROSS, JAMES W (DOCTOR)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:ROSS
Suffix:
Gender:M
Credentials:DOCTOR
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Mailing Address - Street 1:85 BARIBEAU DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-798-7979
Mailing Address - Fax:207-721-0730
Practice Address - Street 1:85 BARIBEAU DRIVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-798-7979
Practice Address - Fax:207-721-0730
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME014942208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME171310099Medicaid
MEMM8927Medicare PIN
MEMM7469Medicare PIN
ME171310099Medicaid