Provider Demographics
NPI:1205826260
Name:CROSSEN, DAVID KEITH (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KEITH
Last Name:CROSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-421-7404
Mailing Address - Fax:804-421-7405
Practice Address - Street 1:7603 FOREST AVE STE 301
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-4937
Practice Address - Country:US
Practice Address - Phone:804-421-7404
Practice Address - Fax:804-421-7405
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03551OtherMEDICARE ID
VA5642990Medicaid
D93764Medicare UPIN
VA080002155Medicare PIN