Provider Demographics
NPI:1184808230
Name:CRUMP, SUMMER RAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:RAE
Last Name:CRUMP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:RAE
Other - Last Name:CRUMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 758963
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8963
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:5000 COX RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-9263
Practice Address - Country:US
Practice Address - Phone:804-822-4351
Practice Address - Fax:804-217-7991
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV5755B - C03895Medicare PIN