Provider Demographics
NPI:1457574519
Name:NORCROSS FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:NORCROSS FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORCROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-541-8919
Mailing Address - Street 1:65A PENINSULA CTR
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3506
Mailing Address - Country:US
Mailing Address - Phone:310-541-8919
Mailing Address - Fax:
Practice Address - Street 1:65A PENINSULA CENTER
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3808
Practice Address - Country:US
Practice Address - Phone:310-541-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty