Provider Demographics
NPI:1417275660
Name:RONALD K. CRISS, D.P.M.,P.C.
Entity Type:Organization
Organization Name:RONALD K. CRISS, D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CRISS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-645-6600
Mailing Address - Street 1:2255 CRAIN HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3164
Mailing Address - Country:US
Mailing Address - Phone:301-645-6600
Mailing Address - Fax:301-645-6601
Practice Address - Street 1:2255 CRAIN HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3164
Practice Address - Country:US
Practice Address - Phone:301-645-6600
Practice Address - Fax:301-645-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00596261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0710750001Medicare NSC
MDT204Medicare PIN