Provider Demographics
NPI:1992890180
Name:CROSSLIN, KEVIN J (MD, FACOG)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:CROSSLIN
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BOGLE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2873
Mailing Address - Country:US
Mailing Address - Phone:606-678-0705
Mailing Address - Fax:606-678-2807
Practice Address - Street 1:333 BOGLE ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2873
Practice Address - Country:US
Practice Address - Phone:606-678-0705
Practice Address - Fax:606-678-2807
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30555207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1410006OtherMEDICARE UNSPECIFIED
KY64305550Medicaid
KY1410006OtherMEDICARE UNSPECIFIED
KY1812701Medicare ID - Type Unspecified