Healthcare Provider Details

I. General information

NPI: 1982940698
Provider Name (Legal Business Name): MATTHEW W CROSS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 07/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSP ORTHOPEDIC SERVICES
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

80 SEYMOUR STREET HARTFORD HOSP ORTHOPEDIC SERVICES
HARTFORD CT
06102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-2245
  • Fax:
Mailing address:
  • Phone: 860-972-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4401
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: