Provider Demographics
NPI:1992744783
Name:ROSS, PATRICK JR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3449
Mailing Address - Country:US
Mailing Address - Phone:610-527-1600
Mailing Address - Fax:610-527-9369
Practice Address - Street 1:100 E LANCASTER AVE STE 222
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-527-1600
Practice Address - Fax:610-527-9369
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041074E208G00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
E51526Medicare UPIN
OHRO0695224Medicare PIN
E51526Medicare UPIN