Provider Demographics
NPI:1285670109
Name:CRUFF, DENNIS M (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:CRUFF
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 1:3000 COLISEUM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5963
Mailing Address - Country:US
Mailing Address - Phone:757-736-7280
Mailing Address - Fax:757-224-3541
Practice Address - Street 1:3000 COLISEUM DR STE 200
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-736-7280
Practice Address - Fax:757-224-3541
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041257208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G22840Medicare UPIN
RI00700796996Medicare ID - Type UnspecifiedARKANSAS BCBS