Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0101042337 | VA |
Y | 208600000X | Surgeon | 0101042337 | VA |
NPI | 1013901636 |
---|---|
Provider Name | Cecil Bernard Cross |
First Address | Baltimore, MD 21297-1334 |
Second Address | Leesburg, VA 20176-5179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 04/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010071780 | (05) | VA |
B06371 | (02) | |
P00142414 | RR MEDICARE (01) |