Provider Demographics
NPI:1811234305
Name:CRUM, KEVIN RAY
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RAY
Last Name:CRUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 SILVER CHARM CIR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3342
Mailing Address - Country:US
Mailing Address - Phone:757-675-6400
Mailing Address - Fax:
Practice Address - Street 1:3031 SILVER CHARM CIR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3342
Practice Address - Country:US
Practice Address - Phone:757-675-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS4308419173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173F00000XOther Service ProvidersSleep Specialist, PhD