Provider Demographics
NPI:1396344859
Name:ROSS, RAYMOND (RT(R)(CT)(MR)(ARRT)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:RT(R)(CT)(MR)(ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 OLEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-3745
Mailing Address - Country:US
Mailing Address - Phone:757-401-5851
Mailing Address - Fax:
Practice Address - Street 1:1325 OLEANDER AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-3745
Practice Address - Country:US
Practice Address - Phone:757-401-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5103942471C3402X, 2471C3401X, 2471M1202X, 335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier