Provider Demographics
NPI:1285892877
Name:CROSBY, NICHOLAS E (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:E
Last Name:CROSBY
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 1:8501 HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2046
Mailing Address - Country:US
Mailing Address - Phone:317-875-9105
Mailing Address - Fax:317-808-8802
Practice Address - Street 1:8501 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2046
Practice Address - Country:US
Practice Address - Phone:317-875-9105
Practice Address - Fax:317-872-6873
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193321207X00000X
IN01072698A207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201178720Medicaid
IN000000881662OtherANTHEM PROVIDER NUMBER
IN201178720OtherMEDICAID HAND SURGERY
IN000000941179OtherANTHEM PROVIDER NUMBER - HAND SURGERY
IN201178720OtherMEDICAID HAND SURGERY
IN201178720Medicaid
IN062110005Medicare PIN