Provider Demographics
NPI:1063415271
Name:CROMWELL, DAVID MCEVOY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MCEVOY
Last Name:CROMWELL
Suffix:
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 1:10751 FALLS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4568
Mailing Address - Country:US
Mailing Address - Phone:410-583-2920
Mailing Address - Fax:
Practice Address - Street 1:10751 FALLS RD STE 401
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-583-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047832207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53589302/KJ49OtherCAREFIRST BCBS
MD4052463 00/766500800Medicaid
MD53589302/KJ49OtherCAREFIRST BCBS
MD4052463 00/766500800Medicaid