Provider Demographics
NPI:1720833734
Name:CRUM, RAPHAEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:
Last Name:CRUM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 N NEGLEY AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1559
Mailing Address - Country:US
Mailing Address - Phone:937-694-7641
Mailing Address - Fax:
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-225-3700
Practice Address - Fax:615-873-8121
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program