Provider Demographics
NPI:1235171646
Name:CRUCIANI, MARK (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:CRUCIANI
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 1:1418 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509
Mailing Address - Country:US
Mailing Address - Phone:570-341-9730
Mailing Address - Fax:570-341-9731
Practice Address - Street 1:1418 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509
Practice Address - Country:US
Practice Address - Phone:570-341-9730
Practice Address - Fax:570-341-9731
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041260L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE55838OtherSTERLING
077077Other1ST PRIORITY
PA614715OtherFEDERAL BLUE SHIELD
505461OtherAETNA
PA614715OtherPA BLUE SHIELD
PA73790OtherMEDPLUS
PA614715OtherFIRST PRIORITY LIFE
PAPC0196OtherCHAMPUS
2Y8654OtherHLTH NET
PA12093 200OtherGEISINGER HEALTH
18787OtherGEISINGER
PA505471OtherAETNA
PA614715OtherFIRST PRIORITY LIFE
E55838Medicare UPIN