Provider Demographics
NPI:1104063049
Name:CROSSWELL HAROUSSEAU, MARGARET KENDALL (PA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:KENDALL
Last Name:CROSSWELL HAROUSSEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:6 GREENWICH OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5151
Mailing Address - Country:US
Mailing Address - Phone:203-869-1145
Mailing Address - Fax:203-618-1721
Practice Address - Street 1:35 CLAREMONT RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1103
Practice Address - Country:US
Practice Address - Phone:914-472-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013056363A00000X
CT4795363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant