Provider Demographics
NPI:1053343038
Name:CROLAND, DAVID ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:CROLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-1009
Mailing Address - Country:US
Mailing Address - Phone:704-243-7106
Mailing Address - Fax:704-243-7108
Practice Address - Street 1:216 WEST NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-1008
Practice Address - Country:US
Practice Address - Phone:704-243-7106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891332EMedicaid
NCP00161312OtherRAILROAD MEDICARE
NC1332EOtherBLUE CROSS BLUE SHIELD
NC2401290CMedicare PIN
F04788Medicare UPIN
NC891332EMedicaid