MEDICARE: MR. JAMES LYNN 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	207VG0400X	Gynecology Physician	3503716	OH

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
2	000000010401	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1861454092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES LYNN CROMWELL MD

Provider Business Mailing Address
First Line	:	2121 EAST HIGH STREET
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1368
Country	:	US
Telephone Number	:	937-323-6865
Fax Number	:	937-323-1803

Provider Business Practice Location Address
First Line	:	2121 EAST HIGH STREET
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1368
Country	:	US
Telephone Number	:	937-323-6865
Fax Number	:	937-323-1803

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	09/08/2011

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