MEDICARE: HENRY LEROY CROMARTIE III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	24965	NC

General Provider Information

NPI Number	:	1245270784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY LEROY CROMARTIE III MD

Provider Business Mailing Address
First Line	:	2901 BLUE RIDGE RD STE 203
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6423
Country	:	US
Telephone Number	:	919-784-6818
Fax Number	:	919-784-6828

Provider Business Practice Location Address
First Line	:	2901 BLUE RIDGE RD STE 203
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6423
Country	:	US
Telephone Number	:	919-784-6818
Fax Number	:	919-784-6828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/29/2022

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