Healthcare Provider Details

I. General information

NPI: 1285892877
Provider Name (Legal Business Name): NICHOLAS E CROSBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 04/01/2024
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 HARCOURT RD
INDIANAPOLIS IN
46260-2046
US

IV. Provider business mailing address

8501 HARCOURT RD
INDIANAPOLIS IN
46260-2046
US

V. Phone/Fax

Practice location:
  • Phone: 317-875-9105
  • Fax: 317-872-6873
Mailing address:
  • Phone: 317-875-9105
  • Fax: 317-808-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMT193321
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01072698A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number01072698A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: