Individual
DR. JOHN RICHARD ROSS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 395-2200
Mailing address
795 COOK RD, ORANGEBURG, SC 29118-2127
(803) 533-7544
(803) 533-7545
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
7709
SC
2086S0129X
Vascular Surgery Physician
Primary
7709
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
077099
—
SC
01
—
7399
MEDICARE GROUP PTAN
SC
Enumeration date
06/09/2005
Last updated
06/08/2023
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