Provider Demographics
NPI:1063411908
Name:CROSSE, KESTER IH II (MD)
Entity type:Individual
Prefix:
First Name:KESTER
Middle Name:IH
Last Name:CROSSE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3258
Mailing Address - Country:US
Mailing Address - Phone:410-992-9797
Mailing Address - Fax:410-730-0942
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3258
Practice Address - Country:US
Practice Address - Phone:410-992-9797
Practice Address - Fax:410-730-0942
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-11-09
Deactivation Date:2006-04-06
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
MDD0059817207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403228400Medicaid
MDKN14G309Medicare PIN
MDH86362Medicare UPIN