Provider Demographics
NPI:1003915018
Name:JAMES J CROSSWELL JR MD PA
Entity Type:Organization
Organization Name:JAMES J CROSSWELL JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JAQUELIN
Authorized Official - Last Name:CROSSWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-728-3875
Mailing Address - Street 1:97 CAMPEN ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516
Mailing Address - Country:US
Mailing Address - Phone:252-728-3875
Mailing Address - Fax:252-728-3594
Practice Address - Street 1:97 CAMPEN ROAD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516
Practice Address - Country:US
Practice Address - Phone:252-728-3875
Practice Address - Fax:252-728-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925970Medicaid
NC8925970Medicaid
NC2336363Medicare PIN