Provider Demographics
NPI:1497962450
Name:CRUSSIAH, TANIA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:RUTH
Last Name:CRUSSIAH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3 BYRKIT DR
Mailing Address - Street 2:SUITE 235
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-1158
Mailing Address - Country:US
Mailing Address - Phone:301-582-1150
Mailing Address - Fax:301-582-0905
Practice Address - Street 1:3 BYRKIT DR
Practice Address - Street 2:SUITE 235
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-1158
Practice Address - Country:US
Practice Address - Phone:301-582-1150
Practice Address - Fax:301-582-0905
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 95139207Q00000X
MDD66288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine