Provider Demographics
NPI:1629177571
Name:KROSS, MARC E (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:E
Last Name:KROSS
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 1:251 E ANTIETAM ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5724
Mailing Address - Country:US
Mailing Address - Phone:301-739-6144
Mailing Address - Fax:301-739-6163
Practice Address - Street 1:251 E ANTIETAM ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5724
Practice Address - Country:US
Practice Address - Phone:301-739-6144
Practice Address - Fax:301-739-6163
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD503372086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD43578Medicare UPIN
012SMedicare PIN
P00044651Medicare PIN