Provider Demographics
NPI:1083666754
Name:CROSS, PHILIP HOWARD (DO)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:HOWARD
Last Name:CROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 OXFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124
Mailing Address - Country:US
Mailing Address - Phone:215-288-0707
Mailing Address - Fax:215-288-9360
Practice Address - Street 1:5363 OXFORD AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124
Practice Address - Country:US
Practice Address - Phone:215-288-0707
Practice Address - Fax:215-288-9360
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05005426L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010250400001Medicaid
D71633Medicare UPIN
460974PMCMedicare ID - Type Unspecified