MEDICARE: DR. PHUONGKHANH HUY CROMWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	200201131	NC
2	208000000X	Pediatrics Physician	0101268121	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	370021704	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1315V	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1043204571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUONGKHANH HUY CROMWELL MD

Provider Business Mailing Address
First Line	:	601 CHILDRENS LN
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1910
Country	:	US
Telephone Number	:	757-668-4805
Fax Number	:

Provider Business Practice Location Address
First Line	:	8264 GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-4127
Country	:	US
Telephone Number	:	804-695-0305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	11/23/2024

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Directions to “ DR. PHUONGKHANH HUY CROMWELL MD” Practice Location

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