Provider Demographics
NPI:1780951889
Name:CRUM, SHARON DIANE
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DIANE
Last Name:CRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:700 GEIPE RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:410-744-0661
Mailing Address - Fax:
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 266
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:410-744-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC4563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant