Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 0101045537 | VA |
NPI | 1003948324 |
---|---|
Provider Name | Elizabeth Mcgill Cross |
First Address | Chester, VA 23831 |
Second Address | Chester, VA 23831-4261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6745504 | (05) | VA |
G92860 | (02) | VA |