Provider Demographics
NPI:1518491745
Name:CRUM, BROOKE A (DO)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:CRUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 W DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2041
Mailing Address - Country:US
Mailing Address - Phone:614-889-7772
Mailing Address - Fax:614-764-0843
Practice Address - Street 1:4335 W DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2041
Practice Address - Country:US
Practice Address - Phone:614-889-7772
Practice Address - Fax:614-764-0843
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013919208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0375183Medicaid