1306899141 NPI number — DR. STEPHEN PAUL CROSSLAND

Table of content: DR. STEPHEN PAUL CROSSLAND (NPI 1306899141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306899141 NPI number — DR. STEPHEN PAUL CROSSLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSSLAND
Provider First Name:
STEPHEN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306899141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GLENN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-2436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-724-0061
Provider Business Mailing Address Fax Number:
301-724-0069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 GLENN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-2436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-724-0061
Provider Business Practice Location Address Fax Number:
301-724-0069
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D025296 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00730703 . This is a "RRMC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000675640 . This is a "MSBCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 92095 . This is a "UNICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 208302 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3810011629 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7137759 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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