Provider Demographics
NPI:1013901636
Name:CROSS, CECIL BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:BERNARD
Last Name:CROSS
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 1:15935 CLARKES GAP RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:VA
Mailing Address - Zip Code:20197-1123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44055 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 246
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5179
Practice Address - Country:US
Practice Address - Phone:703-858-3200
Practice Address - Fax:703-858-3203
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042337208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00142414OtherRR MEDICARE
VA010071780Medicaid
P00142414OtherRR MEDICARE
B06371Medicare UPIN