Provider Demographics
NPI:1699777565
Name:CROMWELL, WILLIAM CAMPBELL (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CAMPBELL
Last Name:CROMWELL
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 1:1500 TRADESCANT COURT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7460
Mailing Address - Country:US
Mailing Address - Phone:919-569-5971
Mailing Address - Fax:919-429-8143
Practice Address - Street 1:8300 HEALTH PARK DRIVE
Practice Address - Street 2:SUITE 320
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-569-5971
Practice Address - Fax:919-429-8143
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925904Medicaid
NC2182759AMedicare ID - Type Unspecified
C78477Medicare UPIN