Provider Demographics
NPI:1487699419
Name:ROSS, DAVID L JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:ROSS
Suffix:JR
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 1:8593 WINTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8593 WINTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4923
Practice Address - Country:US
Practice Address - Phone:513-952-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36975207Q00000X
WI49924207Q00000X
OH35077320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487699419Medicaid
OH2277503Medicaid
KY64041007Medicaid
KY990015625OtherRAILROAD MEDICARE
OH1487699419Medicaid
KY990015625OtherRAILROAD MEDICARE