Provider Demographics
NPI:1952400327
Name:CRUZ, RICHARD LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:CRUZ
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 1:1701 AUGUSTINE CUT OFF
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-656-9707
Mailing Address - Fax:302-656-3064
Practice Address - Street 1:1701 AUGUSTINE CUT OFF
Practice Address - Street 2:SUITE 8
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-656-9707
Practice Address - Fax:302-656-3064
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00024372084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000025145Medicaid
E03570Medicare UPIN
DE1000025145Medicaid