Provider Demographics
NPI:1043266190
Name:CRISMARU, CIPRIAN (MD)
Entity Type:Individual
Prefix:
First Name:CIPRIAN
Middle Name:
Last Name:CRISMARU
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 1:77 W HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-5107
Mailing Address - Country:US
Mailing Address - Phone:901-240-1362
Mailing Address - Fax:
Practice Address - Street 1:799 FARSON ST
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1082
Practice Address - Country:US
Practice Address - Phone:740-401-1150
Practice Address - Fax:740-401-1155
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38901207Q00000X
OH35.139406207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4122559OtherBLUE CROSS
TN33097OtherTLC TENNCARE
MS09682017Medicaid
TNI24111Medicare UPIN