Provider Demographics
NPI:1932147519
Name:CRUMLEY, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:CRUMLEY
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 1:3004 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2343
Mailing Address - Country:US
Mailing Address - Phone:606-248-4131
Mailing Address - Fax:606-248-4133
Practice Address - Street 1:3004 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2343
Practice Address - Country:US
Practice Address - Phone:606-248-4131
Practice Address - Fax:606-248-4133
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900198208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11906OtherBCBSNC
NC8911906Medicaid
NC11906OtherBCBSNC
NCG91938Medicare UPIN