MEDICARE: EDWIN CRUZ MD & CO. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	0101221356	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101221356	OTHER		VIRGINIA LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164757498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWIN CRUZ MD & CO. INC.

Provider Business Mailing Address
First Line	:	1712 STONE CHURCH MEWS
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4374
Country	:	US
Telephone Number	:	757-460-7447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 STONE CHURCH MEWS
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4374
Country	:	US
Telephone Number	:	757-460-7447
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	DR. EDWIN CRUZ
Credential	:	MD
Telephone Number	:	757-460-7447

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	12/21/2009

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