Healthcare Provider Details

I. General information

NPI: 1861656167
Provider Name (Legal Business Name): JAMEY CROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060
US

IV. Provider business mailing address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-2556
  • Fax: 571-231-6666
Mailing address:
  • Phone: 571-231-2556
  • Fax: 571-231-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101248235
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: