1871783316 NPI number — THEODORE H. CRYER, M.D., F.A.C.S.

Table of content: (NPI 1871783316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871783316 NPI number — THEODORE H. CRYER, M.D., F.A.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THEODORE H. CRYER, M.D., F.A.C.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1871783316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1647 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNESBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17268-1874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-762-1158
Provider Business Mailing Address Fax Number:
717-762-8858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1647 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17268-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-762-1158
Provider Business Practice Location Address Fax Number:
717-762-8858
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRYER
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-762-1158

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD019080E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2144599 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3107791 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 32521 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 18278 . This is a "SPECTERA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 322133 . This is a "PHCS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392543 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50003090 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015563110002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1334892 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 67059 . This is a "PENNSYLVANIA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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