Provider Demographics
NPI:1336319250
Name:PAUL D CRYAN
Entity Type:Organization
Organization Name:PAUL D CRYAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DARBY
Authorized Official - Last Name:CRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-688-2304
Mailing Address - Street 1:295 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2609
Mailing Address - Country:US
Mailing Address - Phone:610-688-2304
Mailing Address - Fax:610-254-9384
Practice Address - Street 1:295 OLD EAGLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2609
Practice Address - Country:US
Practice Address - Phone:610-688-2304
Practice Address - Fax:610-254-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002804L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28203Medicare UPIN
PA0602700001Medicare NSC