Individual
ROSS SAMUEL OLIVER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2335 CHESTERFIELD AVENUE,, SUITE 101, CHARLESTON, WV 25304-1066
(304) 344-3785
(304) 344-3765
Mailing address
2335 CHESTERFIELD AVENUE,, SUITE 101, CHARLESTON, WV 25304-1066
(304) 344-3785
(304) 344-3765
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
13925
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721031
BC BS
WV
05
—
0130039000
—
WV
01
—
0216253040000
TRICARE
WV
01
—
1002718509
ACORDIA PEIA
WV
01
—
1393063
MC UMW
WV
01
—
1508836
CIGNA
WV
01
—
185112
SELECT NET
WV
01
—
221960
CARELINK
WV
01
—
340002703
RAILROAD MC
WV
01
—
4242731
AETNA
WV
Enumeration date
10/27/2006
Last updated
05/14/2012
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