Provider Demographics
NPI:1639120926
Name:MCCRUMB, MICHELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:MCCRUMB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 STATE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-5693
Mailing Address - Country:US
Mailing Address - Phone:508-696-8877
Mailing Address - Fax:508-696-8871
Practice Address - Street 1:395 STATE RD
Practice Address - Street 2:STE3
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5693
Practice Address - Country:US
Practice Address - Phone:508-696-8877
Practice Address - Fax:508-696-8871
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1675213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y70739OtherMEDICARE PTAN