Provider Demographics
NPI:1457306003
Name:CRIM, RYAN C (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:CRIM
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 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:354 ALEXANDER SPRING RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7451
Practice Address - Country:US
Practice Address - Phone:717-477-2764
Practice Address - Fax:717-839-2772
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070365L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACR000719299OtherPA BLUE SHIELD
PA001846652Medicaid
PA0018466520005Medicaid
PACR000719299OtherPA BLUE SHIELD