Provider Demographics
NPI:1851377857
Name:CROUSE, CHARLES DAVID II (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:CROUSE
Suffix:II
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 1:1524 APPERSON DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1524 APPERSON DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7219
Practice Address - Country:US
Practice Address - Phone:434-989-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236620207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10-01813OtherUNITED HEALTHCARE OF VIRGINIA
VA010079624Medicaid
183014OtherANTHEM AND HEALTHKEEPERS
316948OtherSOUTHERN HEALTH
010079624OtherVIRGINIA PREMIER (MEDICAID HMO)
VAP00276841OtherMEDICARE RAILROAD
TN0113OtherRIVER VALLEY
3123459OtherMAMSI HEALTH PLANS
7432600OtherAETNA US HEALTHCARE
183014OtherANTHEM AND HEALTHKEEPERS
7432600OtherAETNA US HEALTHCARE