| Crossroads Medical Group | |
|
4801 Dorsey Hall Dr Suite 201 Ellicott City MD 21042-7766 | |
| (410) 997-5191 | |
| (410) 997-7957 |
| Full Name | Crossroads Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 4801 Dorsey Hall Dr, Ellicott City, Maryland |
| Authorized Official Name and Position | Joel Suldan (VICE PRESIDENT) |
| Authorized Official Contact | 4106015129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Medical Group 4801 Dorsey Hall Dr Suite 201 Ellicott City MD 21042-7766 Ph: (410) 997-5191 | Crossroads Medical Group 4801 Dorsey Hall Dr Suite 201 Ellicott City MD 21042-7766 Ph: (410) 997-5191 |
| NPI Number | 1124433628 |
|---|---|
| Provider Enumeration Date | 06/24/2014 |
| Last Update Date | 04/09/2015 |
| Medicare PECOS PAC ID | 0446470165 |
|---|---|
| Medicare Enrollment ID | O20141001001162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124433628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Maryland) | Primary |
| Provider Name | Parry A Moore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760467880 PECOS PAC ID: 7416911219 Enrollment ID: I20041111001039 |
| Provider Name | Marie-alberte Boursiquot |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578571618 PECOS PAC ID: 3072578962 Enrollment ID: I20041119000468 |
| Provider Name | Rupal R Desai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376634626 PECOS PAC ID: 8426000373 Enrollment ID: I20050218000433 |
| Provider Name | Indrayani M Karkhanis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164413852 PECOS PAC ID: 2365472388 Enrollment ID: I20080313000301 |
| Provider Name | Cheryl D Leonardi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215912332 PECOS PAC ID: 7517958408 Enrollment ID: I20100218000300 |
| Provider Name | Warren Marc Ross |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770568891 PECOS PAC ID: 7810032919 Enrollment ID: I20100301000329 |
| Provider Name | Joseph J. Aleo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831176577 PECOS PAC ID: 4486799962 Enrollment ID: I20100309000157 |
| Provider Name | Steven H Eversley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144205865 PECOS PAC ID: 8628113966 Enrollment ID: I20100311000023 |
| Provider Name | Jonathan Bayer Schiller |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831206283 PECOS PAC ID: 7517197882 Enrollment ID: I20140306000568 |
| Provider Name | Lauren S Cano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912395310 PECOS PAC ID: 8729305172 Enrollment ID: I20150323002024 |
| Provider Name | Adejoke Sijuwade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811274632 PECOS PAC ID: 3779734611 Enrollment ID: I20180307000507 |
| Provider Name | Jane Kapustin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114921681 PECOS PAC ID: 0143571091 Enrollment ID: I20180917001425 |
| Provider Name | Ruth Angela Fahnestock Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144860479 PECOS PAC ID: 9436586021 Enrollment ID: I20200220000481 |
| Provider Name | Diane M Kepner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487626461 PECOS PAC ID: 5991990723 Enrollment ID: I20220215000543 |
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Jeffrey R. Kaplan M.d. Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5116 Dorsey Hall Dr Ste A, Ellicott City, MD 21042 Phone: 410-964-9300 Fax: 410-964-9822 | |
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