MEDICARE: COQUILLA DEBORAH CROSS 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	2084P0800X	Psychiatry Physician	D0097839	MD

General Provider Information

NPI Number	:	1235197013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COQUILLA DEBORAH CROSS MD

Provider Business Mailing Address
First Line	:	849 FAIRMOUNT AVE FL 5
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-2624
Country	:	US
Telephone Number	:	443-377-5273
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 N CHARLES ST
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-6819
Country	:	US
Telephone Number	:	410-938-5000
Fax Number	:

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	07/15/2024

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