Provider Demographics
NPI:1780151654
Name:ROSS, EUGENE ALLEN JR
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:ALLEN
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 7TH ST NW APT 36
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3498
Mailing Address - Country:US
Mailing Address - Phone:202-848-9018
Mailing Address - Fax:
Practice Address - Street 1:1710 7TH ST NW APT 36
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3498
Practice Address - Country:US
Practice Address - Phone:202-848-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty