1366403958 NPI number — DR. EDWARD MICHAEL CROSLAND MD

Table of content: DR. EDWARD MICHAEL CROSLAND MD (NPI 1366403958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366403958 NPI number — DR. EDWARD MICHAEL CROSLAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSLAND
Provider First Name:
EDWARD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1366403958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1706 MAGNOLIA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30909-9481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-210-7529
Provider Business Mailing Address Fax Number:
706-312-7610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 HIGH GATE LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29803-3921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-265-8117
Provider Business Practice Location Address Fax Number:
803-265-2502
Provider Enumeration Date:
03/31/2006

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: 207X00000X , with the licence number:  17638 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 028156 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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