Healthcare Provider Details

I. General information

NPI: 1043204571
Provider Name (Legal Business Name): PHUONGKHANH HUY CROMWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 11/23/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4127
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 804-695-0305
  • Fax:
Mailing address:
  • Phone: 757-668-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200201131
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101268121
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: