Provider Demographics
NPI:1164757498
Name:EDWIN CRUZ MD & CO. INC.
Entity Type:Organization
Organization Name:EDWIN CRUZ MD & CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-460-7447
Mailing Address - Street 1:1712 STONE CHURCH MEWS
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4374
Mailing Address - Country:US
Mailing Address - Phone:757-460-7447
Mailing Address - Fax:
Practice Address - Street 1:1712 STONE CHURCH MEWS
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4374
Practice Address - Country:US
Practice Address - Phone:757-460-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221356207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101221356OtherVIRGINIA LICENSE
VA5828571Medicaid
VA110007470Medicare PIN
VA5828571Medicaid
C01832Medicare UPIN
VAC10889Medicare PIN