Provider Demographics
NPI:1861490500
Name:MICHAEL E CROUCH MD PA
Entity Type:Organization
Organization Name:MICHAEL E CROUCH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-546-3243
Mailing Address - Street 1:105 PINE BLUFF RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7160
Mailing Address - Country:US
Mailing Address - Phone:410-546-3243
Mailing Address - Fax:410-546-2926
Practice Address - Street 1:105 PINE BLUFF RD
Practice Address - Street 2:SUITE 7
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7160
Practice Address - Country:US
Practice Address - Phone:410-546-3243
Practice Address - Fax:410-546-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26612207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25952-1400Medicaid
D74591Medicare UPIN
MD25952-1400Medicaid