1851377857 NPI number — CHARLES DAVID CROUSE II M.D.

Table of content: CHARLES DAVID CROUSE II M.D. (NPI 1851377857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851377857 NPI number — CHARLES DAVID CROUSE II M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROUSE
Provider First Name:
CHARLES
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851377857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 APPERSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24153-7219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 APPERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153-7219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-989-5281
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  0101236620 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10-01813 . This is a "UNITED HEALTHCARE OF VIRGINIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010079624 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 183014 . This is a "ANTHEM AND HEALTHKEEPERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 316948 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010079624 . This is a "VIRGINIA PREMIER (MEDICAID HMO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00276841 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: TN0113 . This is a "RIVER VALLEY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3123459 . This is a "MAMSI HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7432600 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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