Provider Demographics
NPI:1881186773
Name:KRUSE, TODD A (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:KRUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HIGH ST STE 4001
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3111
Mailing Address - Country:US
Mailing Address - Phone:570-321-2345
Mailing Address - Fax:
Practice Address - Street 1:740 HIGH ST STE 4001
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3111
Practice Address - Country:US
Practice Address - Phone:570-321-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine