Healthcare Provider Details

I. General information

NPI: 1285213405
Provider Name (Legal Business Name): DOMINIQUE R CROSS DO, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 BUTTERFLY GARDENS DR
COLUMBUS OH
43215-4985
US

IV. Provider business mailing address

12 W GAY ST APT 542
COLUMBUS OH
43215-3067
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-3194
  • Fax:
Mailing address:
  • Phone: 504-914-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number34.018087
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.018087
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number34.018087
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.018087
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: