Provider Demographics
NPI:1760473599
Name:ROBERT D CROUCH, MD, PA
Entity Type:Organization
Organization Name:ROBERT D CROUCH, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-663-4774
Mailing Address - Street 1:900 TOLL HOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4547
Mailing Address - Country:US
Mailing Address - Phone:301-663-4774
Mailing Address - Fax:301-695-1364
Practice Address - Street 1:900 TOLL HOUSE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4547
Practice Address - Country:US
Practice Address - Phone:301-663-4774
Practice Address - Fax:301-695-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00976208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLP29ROOtherBCBS
MD685LMedicare ID - Type UnspecifiedMEDICARE
1064570001Medicare NSC