Provider Demographics
NPI:1316671233
Name:ROSS, MAXINE
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2642
Mailing Address - Country:US
Mailing Address - Phone:301-385-8630
Mailing Address - Fax:
Practice Address - Street 1:1616 MARION ST NW APT 228
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3473
Practice Address - Country:US
Practice Address - Phone:202-290-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant