Provider Demographics
NPI:1013974153
Name:CROSBY, KIM LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:LEIGH
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 COURT DR
Mailing Address - Street 2:STE 110
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:919-781-9078
Mailing Address - Fax:919-719-0147
Practice Address - Street 1:2391 COURT DR
Practice Address - Street 2:STE 110
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-853-3330
Practice Address - Fax:704-853-8951
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-00033208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG69117Medicare UPIN