Provider Demographics
NPI:1316940901
Name:MARBURGER, ROSS EDWARD (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:EDWARD
Last Name:MARBURGER
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 1:1150 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1071
Mailing Address - Country:US
Mailing Address - Phone:812-402-4263
Mailing Address - Fax:812-437-4263
Practice Address - Street 1:1150 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1071
Practice Address - Country:US
Practice Address - Phone:812-402-4263
Practice Address - Fax:812-437-4263
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045234A207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000042273OtherANTHEM BCBS
IN0231480001OtherMEDICARE DME
IN2000096300AMedicaid
IN0231480001OtherMEDICARE DME
ING10872Medicare UPIN
6416590001Medicare NSC