MEDICARE: WILLIAM CAMPBELL CROMWELL M.D.

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	207Q00000X	Family Medicine Physician	200201569	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699777565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM CAMPBELL CROMWELL M.D.

Provider Business Mailing Address
First Line	:	1500 TRADESCANT COURT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-7460
Country	:	US
Telephone Number	:	919-569-5971
Fax Number	:	919-429-8143

Provider Business Practice Location Address
First Line	:	8300 HEALTH PARK DRIVE
Second Line	:	SUITE 320
City	:	RALEIGH
State	:	NC
Zip	:	27615-4731
Country	:	US
Telephone Number	:	919-569-5971
Fax Number	:	919-429-8143

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	10/09/2012

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