Individual
DR. ANTHONY L DEROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7874
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
229244
MA
2086S0120X
Pediatric Surgery Physician
Primary
35-095425
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025751090001
—
PA
05
—
2122634
—
MA
05
—
3051852
—
OH
Enumeration date
05/12/2006
Last updated
05/25/2011
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