Provider Demographics
NPI:1194953596
Name:CROSSWELL, EDWARD GRANDERSON (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GRANDERSON
Last Name:CROSSWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1920 PICKENS ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2632
Mailing Address - Country:US
Mailing Address - Phone:803-779-3070
Mailing Address - Fax:803-771-7639
Practice Address - Street 1:1920 PICKENS ST.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2632
Practice Address - Country:US
Practice Address - Phone:803-779-3070
Practice Address - Fax:803-771-7639
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2020-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCLL31756207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology