Provider Demographics
NPI:1346279155
Name:CROSSROADS MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CROSSROADS MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ENEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-785-9500
Mailing Address - Street 1:1320 CENTRAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4942
Mailing Address - Country:US
Mailing Address - Phone:540-785-9500
Mailing Address - Fax:540-785-0206
Practice Address - Street 1:1320 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4942
Practice Address - Country:US
Practice Address - Phone:540-785-9500
Practice Address - Fax:540-785-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06938Medicare PIN