Provider Demographics
NPI:1992730287
Name:ROSS, ALAN JASON (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:JASON
Last Name:ROSS
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 1:8311 WISCONSIN AVE
Mailing Address - Street 2:#C14
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-654-5225
Mailing Address - Fax:
Practice Address - Street 1:8311 WISCONSIN AVE
Practice Address - Street 2:#C14
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-654-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
014869W52OtherPROVIDER FOR MC #
D72421Medicare UPIN
164752Medicare ID - Type Unspecified