Provider Demographics
NPI:1104614361
Name:CROSSON, JOHN A
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:CROSSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2082
Mailing Address - Country:US
Mailing Address - Phone:860-965-5523
Mailing Address - Fax:860-899-1050
Practice Address - Street 1:226 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2082
Practice Address - Country:US
Practice Address - Phone:860-901-2097
Practice Address - Fax:860-899-1050
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004657208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation