Basic Information
| Provider Information | |||||||||
| NPI: | 1609832989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2014 WASHINGTON ST | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024621607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172436140 | ||||||||
| FaxNumber: | 6172435809 | ||||||||
| Practice Location | |||||||||
| Address1: | 2014 WASHINGTON ST | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024621607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172436140 | ||||||||
| FaxNumber: | 6172435809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 54450 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 054450 | 01 | MA | TUFTS HEALTH PLAN POS | OTHER | 000000021384 | 01 | MA | BOSTON CITY HEALTH NET | OTHER | 803550 | 01 | MA | SECURE HORIZENS | OTHER | 3004015 | 05 | MA | MEDICAID | 34280 | 01 | MA | HPHC | OTHER | 34280 | 01 | MA | HPHC FIRST SENIORITY | OTHER | 220017017 | 01 | MA | MEDICARE RR | OTHER |