Basic Information
| Provider Information | |||||||||
| NPI: | 1932105632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | SHANNAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3780 MEDINA RD STE 220 | ||||||||
| Address2: | |||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442569312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307236060 | ||||||||
| FaxNumber: | 3307236462 | ||||||||
| Practice Location | |||||||||
| Address1: | 3780 MEDINA RD STE 220 | ||||||||
| Address2: | |||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442569312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307236060 | ||||||||
| FaxNumber: | 3307236462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35-082532R | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7349474 | 01 | OH | AETNA | OTHER | 000000298482 | 01 | OH | ANTHEM | OTHER | 2401814 | 05 | OH | MEDICAID |