Healthcare Provider Details

I. General information

NPI: 1891868832
Provider Name (Legal Business Name): MARY MCCROSSAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST STE 200
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

PO BOX 824804
PHILADELPHIA PA
19182-4804
US

V. Phone/Fax

Practice location:
  • Phone: 302-575-8041
  • Fax: 302-575-8005
Mailing address:
  • Phone: 302-575-8040
  • Fax: 302-575-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10004850
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: