Provider Demographics
NPI:1376507517
Name:CRUSE, JAMES GARLAND (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GARLAND
Last Name:CRUSE
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 1:601 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1445
Mailing Address - Country:US
Mailing Address - Phone:570-253-8226
Mailing Address - Fax:570-253-8228
Practice Address - Street 1:600 MAPLE AVE STE 2
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1436
Practice Address - Country:US
Practice Address - Phone:570-251-6672
Practice Address - Fax:570-251-6668
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029153090001Medicaid
G66630Medicare UPIN
PA1029153090001Medicaid
O8BBSWHMedicare ID - Type Unspecified