Provider Demographics
NPI:1861454092
Name:CROMWELL, JAMES LYNN (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LYNN
Last Name:CROMWELL
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 1:2121 EAST HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1368
Mailing Address - Country:US
Mailing Address - Phone:937-323-6865
Mailing Address - Fax:937-323-1803
Practice Address - Street 1:2121 EAST HIGH STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1368
Practice Address - Country:US
Practice Address - Phone:937-323-6865
Practice Address - Fax:937-323-1803
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3503716207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0242768Medicaid
OH000000010401OtherANTHEM
OH0242768Medicaid
OH000000010401OtherANTHEM