=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326231424
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID M. CROMWELL, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10751 FALLS RD STE 401
-----------------------------------------------------
City | LUTHERVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-4517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-583-2920
-----------------------------------------------------
Fax | 410-583-2925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10751 FALLS RD STE 401
-----------------------------------------------------
City | LUTHERVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-4517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-583-2920
-----------------------------------------------------
Fax | 410-583-2925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CHRISTINE MARY DENNISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-583-2920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | D0047832
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------