Healthcare Provider Details

I. General information

NPI: 1326326588
Provider Name (Legal Business Name): JAMES DEWITT CROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 FARMINGTON AVE # RE52
HARTFORD CT
06156-0001
US

IV. Provider business mailing address

151 FARMINGTON AVE # RE52
HARTFORD CT
06156-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-273-5456
  • Fax: 860-273-0850
Mailing address:
  • Phone: 860-273-5456
  • Fax: 860-273-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number032159
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD32127
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE9170
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22017
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: