Provider Demographics
NPI:1598754632
Name:CROSS, ANALISA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANALISA
Middle Name:
Last Name:CROSS
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:PO BOX 602695
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2695
Mailing Address - Country:US
Mailing Address - Phone:704-289-9461
Mailing Address - Fax:704-282-2472
Practice Address - Street 1:412 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5600
Practice Address - Country:US
Practice Address - Phone:704-289-9461
Practice Address - Fax:704-282-2472
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33804207R00000X
SC13017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925948Medicaid
SC130174Medicaid
NC1598754632Medicaid
D05755Medicare UPIN
NC8925948Medicaid
NC1598754632Medicaid
NCNC4748DMedicare PIN
NCNC4748JMedicare PIN
SCAA41191909Medicare PIN
NCNC4748FMedicare PIN
NC2159236AMedicare PIN
NCNC4748AMedicare PIN
SC130174Medicaid
NCNC4748IMedicare PIN
NC2159236BMedicare PIN
NCNC4748BMedicare PIN