Provider Demographics
NPI:1023719366
Name:CROSSOVER MEDICAL LLC
Entity type:Organization
Organization Name:CROSSOVER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROTIMI
Authorized Official - Middle Name:ADEGOKE
Authorized Official - Last Name:ILUYOMADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-379-7736
Mailing Address - Street 1:6922 LITTLE RIVER TURNPIKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ANNADALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-705-9306
Mailing Address - Fax:
Practice Address - Street 1:6922 LITTLE RIVER TURNPIKE
Practice Address - Street 2:SUITE D
Practice Address - City:ANNADALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-705-9306
Practice Address - Fax:703-890-3114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSOVER MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty