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General NPI Number Information
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NPI Number | 1790994812
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Entity Type | Individual
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Provider Name | TERENCE SCOTT CROSBY PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2501 PARKERS LN
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3209
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Country | US
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Telephone | 703-664-7264
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 LINDEN PL NE
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City | WASHINGTON
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State | DC
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Zip | 20002-4454
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Country | US
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Telephone | 202-412-1268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0110840863
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License Number State | VA
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