Provider Demographics
NPI:1801815634
Name:CROSS, SAMUEL E II (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:CROSS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-0266
Mailing Address - Country:US
Mailing Address - Phone:989-621-0599
Mailing Address - Fax:
Practice Address - Street 1:1037 COMPASS CIR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2786
Practice Address - Country:US
Practice Address - Phone:724-834-1144
Practice Address - Fax:724-552-2086
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073384L208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM41100-012Medicare PIN