Provider Demographics
NPI:1245270784
Name:CROMARTIE, HENRY LEROY III (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:LEROY
Last Name:CROMARTIE
Suffix:III
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 1:2901 BLUE RIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6423
Mailing Address - Country:US
Mailing Address - Phone:919-784-6818
Mailing Address - Fax:919-784-6828
Practice Address - Street 1:2901 BLUE RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6423
Practice Address - Country:US
Practice Address - Phone:919-784-6818
Practice Address - Fax:919-784-6828
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24965207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925795Medicaid
C86449Medicare UPIN
NC205658FMedicare PIN