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NPI Code Detail

MEDICARE: DR. DANIEL LIND CROCKER M.D.

MEDICARE: DR. DANIEL LIND CROCKER M.D.
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
1207RH0003XHematology & Oncology Physician16848NC
2207R00000XInternal Medicine Physician16848NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1451911OTHERNCUNITED HEALTHCARE ID
295350OTHERNCMEDCOST ID
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41105986OTHERNCFIRST HEALTH ID
57106359OTHERNCCIGNA HEALTHCARE ID
625771OTHERNCBC BS OF NC ID
75928133OTHERNCAETNA ID

General Provider Information

NPI Number : 1700886272
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL LIND CROCKER M.D.
Provider Business Mailing Address
First Line : 325 BROAD ST
Second Line : STE 100
City : SUMTER
State : SC
Zip : 29150-4167
Country : US
Telephone Number : 803-773-5227
Fax Number : 803-746-7445
Provider Business Practice Location Address
First Line : 1041 NOELL LN
Second Line : SUITE 105
City : ROCKY MOUNT
State : NC
Zip : 27804-2058
Country : US
Telephone Number : 252-451-2700
Fax Number : 252-451-2702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2005
Last Update Date : 09/21/2018

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