Provider Demographics
NPI:1457301996
Name:CROSSWELL, WILLIAM FORT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FORT
Last Name:CROSSWELL
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 1:1920 PICKENS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2632
Mailing Address - Country:US
Mailing Address - Phone:803-779-3070
Mailing Address - Fax:803-771-7639
Practice Address - Street 1:1920 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-779-3070
Practice Address - Fax:803-771-7639
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6356207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC063567Medicaid
SC063567Medicaid
SCB919161357Medicare PIN