Provider Demographics
NPI:1750417218
Name:CRISS, RONALD K (DPM, PC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:K
Last Name:CRISS
Suffix:
Gender:M
Credentials:DPM, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CRAIN HWY
Mailing Address - Street 2:SUITE #102
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3186
Mailing Address - Country:US
Mailing Address - Phone:301-645-6600
Mailing Address - Fax:301-645-6601
Practice Address - Street 1:2255 CRAIN HWY
Practice Address - Street 2:SUITE #102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3186
Practice Address - Country:US
Practice Address - Phone:301-645-6600
Practice Address - Fax:301-645-6601
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00596213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD266248500Medicaid
MD266248500Medicaid
MD0710750001Medicare NSC
MDT204Medicare PIN
MDT59861Medicare UPIN