Provider Demographics
NPI:1366403958
Name:CROSLAND, EDWARD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:CROSLAND
Suffix:
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 1:1706 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9481
Mailing Address - Country:US
Mailing Address - Phone:706-210-7529
Mailing Address - Fax:706-312-7610
Practice Address - Street 1:211 HIGH GATE LOOP
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3921
Practice Address - Country:US
Practice Address - Phone:803-265-8117
Practice Address - Fax:803-265-2502
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17638207X00000X
GA028156207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000428282BMedicaid
GA00428282AMedicaid
SCG28156Medicaid
SCG28156Medicaid
GA000428282BMedicaid
GA00428282AMedicaid