Provider Demographics
NPI:1104803170
Name:CRUMP, JASON THOMAS (PAC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:THOMAS
Last Name:CRUMP
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 CHAPIN ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-5501
Mailing Address - Country:US
Mailing Address - Phone:540-915-7195
Mailing Address - Fax:
Practice Address - Street 1:8517 CHAPIN STREET
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-4008
Practice Address - Country:US
Practice Address - Phone:540-915-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021257363A00000X
RIPA01297363A00000X
VA0110002195363A00000X
WV2338363A00000X
MAPA9410363A00000X
CT5102363A00000X
MEPA1791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant