Provider Demographics
NPI:1417946716
Name:CROSKEY, DJENABRA M (MD)
Entity Type:Individual
Prefix:
First Name:DJENABRA
Middle Name:M
Last Name:CROSKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 LOWNDES HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2101
Mailing Address - Country:US
Mailing Address - Phone:864-908-3530
Mailing Address - Fax:864-627-9920
Practice Address - Street 1:777 LOWNDES HILL RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2101
Practice Address - Country:US
Practice Address - Phone:864-908-3530
Practice Address - Fax:864-627-9920
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91316207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271084600Medicaid
FL52015AMedicare ID - Type Unspecified
FL271084600Medicaid