Provider Demographics
NPI:1053644088
Name:MCCROSKEY, SAMUEL A
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:A
Last Name:MCCROSKEY
Suffix:
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 1:1208 AUGUSTA ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4024
Mailing Address - Country:US
Mailing Address - Phone:864-242-3995
Mailing Address - Fax:864-242-3985
Practice Address - Street 1:1208 AUGUSTA ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4024
Practice Address - Country:US
Practice Address - Phone:864-242-3995
Practice Address - Fax:864-242-3985
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist