MEDICARE: DANIEL B CRUMP M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	34874	KY
2	207ZD0900X	Dermatopathology (Pathology) Physician	34874	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4000501	OTHER	KY	MEDICARE LAB GROUP
2	CB5773	OTHER	KY	RR MEDICARE GROUP NUMBER
4	P00422199	OTHER	KY	RR MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750374955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL B CRUMP M.D.

Provider Business Mailing Address
First Line	:	1221 S BROADWAY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2701
Country	:	US
Telephone Number	:	859-258-4000
Fax Number	:	859-258-4796

Provider Business Practice Location Address
First Line	:	800 ROSE ST # MS 119
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-2701
Country	:	US
Telephone Number	:	859-257-1446
Fax Number	:	859-257-7572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/20/2019

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Directions to “ DANIEL B CRUMP M.D.” Practice Location

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