Provider Demographics
NPI:1700886272
Name:CROCKER, DANIEL LIND (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LIND
Last Name:CROCKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:325 BROAD ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4167
Mailing Address - Country:US
Mailing Address - Phone:803-773-5227
Mailing Address - Fax:803-746-7445
Practice Address - Street 1:1041 NOELL LN
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2058
Practice Address - Country:US
Practice Address - Phone:252-451-2700
Practice Address - Fax:252-451-2702
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2018-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC16848207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC451911OtherUNITED HEALTHCARE ID
NC95350OtherMEDCOST ID
NC8925771Medicaid
NC1105986OtherFIRST HEALTH ID
NC7106359OtherCIGNA HEALTHCARE ID
NC25771OtherBC BS OF NC ID
NC5928133OtherAETNA ID
NC451911OtherUNITED HEALTHCARE ID
NC1105986OtherFIRST HEALTH ID
NC25771OtherBC BS OF NC ID