Provider Demographics
NPI:1013614387
Name:CROSS, DONALD CRAIG
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:CRAIG
Last Name:CROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10554 ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23437-8545
Mailing Address - Country:US
Mailing Address - Phone:757-657-6596
Mailing Address - Fax:
Practice Address - Street 1:10437 ELLIS RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23437-8555
Practice Address - Country:US
Practice Address - Phone:757-617-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program