Provider Demographics
NPI:1881687762
Name:CRUISE, RODELL E JR (MD)
Entity Type:Individual
Prefix:
First Name:RODELL
Middle Name:E
Last Name:CRUISE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2009 TIDEWATER COLONY DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2107
Mailing Address - Country:US
Mailing Address - Phone:410-224-0010
Mailing Address - Fax:410-224-0012
Practice Address - Street 1:2009 TIDEWATER COLONY DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2107
Practice Address - Country:US
Practice Address - Phone:410-224-0010
Practice Address - Fax:410-224-0012
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0054076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005622093Medicaid
GA080180343OtherRAILROAD MEDICARE
VA005622093Medicaid
GA080180343OtherRAILROAD MEDICARE