Basic Information
| Provider Information | |||||||||
| NPI: | 1710919931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2320 WOOLSEY ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947051973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108438002 | ||||||||
| FaxNumber: | 5105404808 | ||||||||
| Practice Location | |||||||||
| Address1: | 2320 WOOLSEY ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947051973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108438002 | ||||||||
| FaxNumber: | 5105404808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 01/31/2014 | ||||||||
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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 | 207R00000X | G074867 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.