Provider Demographics
NPI:1194780528
Name:ESTRADA, CROMWELL C (DO)
Entity type:Individual
Prefix:
First Name:CROMWELL
Middle Name:C
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:484-526-6500
Practice Address - Street 1:3050 HAMILTON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3691
Practice Address - Country:US
Practice Address - Phone:610-437-7181
Practice Address - Fax:610-435-0597
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009758L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG93793Medicare UPIN
PA027524Medicare ID - Type UnspecifiedMEDICARE