Provider Demographics
NPI:1528352804
Name:ROSS, AHMARA GIBBONS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:AHMARA
Middle Name:GIBBONS
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:AHMARA
Other - Middle Name:VIVIAN
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:SUITE 515
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-8069
Mailing Address - Fax:
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:SUITE 515
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2014-0656207W00000X
PAMD454778207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology