Healthcare Provider Details

I. General information

NPI: 1003915018
Provider Name (Legal Business Name): JAMES J CROSSWELL JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 CAMPEN ROAD
BEAUFORT NC
28516
US

IV. Provider business mailing address

97 CAMPEN ROAD
BEAUFORT NC
28516
US

V. Phone/Fax

Practice location:
  • Phone: 252-728-3875
  • Fax: 252-728-3594
Mailing address:
  • Phone: 252-728-3875
  • Fax: 252-728-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28568
License Number StateNC

VIII. Authorized Official

Name: DR. JAMES JAQUELIN CROSSWELL JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 252-728-3875