Provider Demographics
NPI:1972577096
Name:CROSSLEY, SUSAN (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CROSSLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-3110
Mailing Address - Fax:508-368-3113
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 150 S
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3110
Practice Address - Fax:508-368-3113
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA193924367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
3163834OtherCIGNA HEALTH PLAN
39861OtherHEALTHY START
0381250OtherMEDICAID WELFARE
CN0160OtherBLUE SHIELD INDEMNITY
381305OtherMVP HEALTH CARE
AA3470OtherHARVARD PILGRIM
042472266OtherTHREE RIVERS
CN0160OtherBLUE CARE ELECT
CN0160OtherBLUE SHIELD HMO BLUE
MA0381250Medicaid
39861OtherCHILDRENS MED SECURITY
61212OtherFALLON COMMUNITY HEALTH
7977623OtherAETNA US HEALTHCARE
RN0018OtherMEDICARE B
04247226OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
AA3470OtherHARVARD PILGRIM
CN0160OtherBLUE CARE ELECT