Provider Demographics
NPI:1477575413
Name:CROS, DIDIER (MD)
Entity type:Individual
Prefix:DR
First Name:DIDIER
Middle Name:
Last Name:CROS
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 1:1 HAWTHORNE PLACE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-720-0030
Mailing Address - Fax:617-720-0055
Practice Address - Street 1:1 HAWTHORNE PLACE
Practice Address - Street 2:SUITE 105
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-720-0030
Practice Address - Fax:617-720-0055
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA586852084N0400X
MAP586852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
M19362OtherBLUE CROSS
MAJ10191OtherBCBS MA
MA724855OtherTUFTS HEALTH PLAN
MA3069257Medicaid
MA724855OtherTUFTS HEALTH PLAN
MAJ10191OtherBCBS MA
J10191Medicare PIN