Basic Information
| Provider Information | |||||||||
| NPI: | 1407881709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCROSSON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751649 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437891620 | ||||||||
| FaxNumber: | 8437242454 | ||||||||
| Practice Location | |||||||||
| Address1: | 3510 N HIGHWAY 17 STE 105 | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294668228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437891850 | ||||||||
| FaxNumber: | 8437242551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 17878 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | 17878 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00952998 | 01 | SC | RAILROAD MC ID-RSFPN | OTHER | 5551 | 01 | MEDICARE GROUP NUMBER | OTHER | GP4854 | 01 | SC | MEDICAID GROUP # | OTHER | 178783 | 05 | SC | MEDICAID | P00605881 | 01 | SC | RAILROAD MEDICARE ID# | OTHER |