Provider Demographics
NPI:1598296337
Name:CROSS, DONIQUE (MD)
Entity Type:Individual
Prefix:
First Name:DONIQUE
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONIQUE
Other - Middle Name:ALYSSA
Other - Last Name:PARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7671 QUARTERFIELD RD STE 401
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4981
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7671 QUARTERFIELD RD STE 401
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4981
Practice Address - Country:US
Practice Address - Phone:443-270-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0089432207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program