Provider Demographics
NPI:1942553995
Name:ROS, OLIANA (MD)
Entity type:Individual
Prefix:
First Name:OLIANA
Middle Name:
Last Name:ROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-426-2323
Mailing Address - Fax:570-426-2761
Practice Address - Street 1:1655 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1023
Practice Address - Country:US
Practice Address - Phone:570-426-2323
Practice Address - Fax:570-426-2761
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD455544207Q00000X
PAMT202911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030504570001Medicaid
PA1030504570001Medicaid