Provider Demographics
NPI:1306899141
Name:CROSSLAND, STEPHEN PAUL
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:CROSSLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GLENN ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2436
Mailing Address - Country:US
Mailing Address - Phone:301-724-0061
Mailing Address - Fax:301-724-0069
Practice Address - Street 1:200 GLENN ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2436
Practice Address - Country:US
Practice Address - Phone:301-724-0061
Practice Address - Fax:301-724-0069
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD025296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00730703OtherRRMC
WV000675640OtherMSBCBS
WV92095OtherUNICARE
VA208302OtherANTHEM BCBS
WV3810011629Medicaid
WV7137759OtherAETNA
VA208302OtherANTHEM BCBS