Provider Demographics
NPI:1326231424
Name:DAVID M. CROMWELL, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID M. CROMWELL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-583-2920
Mailing Address - Street 1:10751 FALLS RD
Mailing Address - Street 2:STE 401
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4517
Mailing Address - Country:US
Mailing Address - Phone:410-583-2920
Mailing Address - Fax:410-583-2925
Practice Address - Street 1:10751 FALLS RD
Practice Address - Street 2:STE 401
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4517
Practice Address - Country:US
Practice Address - Phone:410-583-2920
Practice Address - Fax:410-583-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047832207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4052463 00Medicaid
MD53589302OtherCAREFIRST BCBS
MDG18449Medicare UPIN