Provider Demographics
NPI:1750374955
Name:CRUMP, DANIEL B (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:CRUMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4000
Mailing Address - Fax:859-258-4796
Practice Address - Street 1:800 ROSE ST # MS 119
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2701
Practice Address - Country:US
Practice Address - Phone:859-257-1446
Practice Address - Fax:859-257-7572
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34874207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE LAB GROUP
KYCB5773OtherRR MEDICARE GROUP NUMBER
KY7100022670Medicaid
KYP00422199OtherRR MEDICARE NUMBER
KY37903705OtherMEDICAID LAB GROUP
KY37903705OtherMEDICAID LAB GROUP
KY7100022670Medicaid