Healthcare Provider Details

I. General information

NPI: 1881447191
Provider Name (Legal Business Name): TEYON JAMAL CRUDUP SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 FINDLAY RD
BALTIMORE MD
21206-6410
US

IV. Provider business mailing address

4415 FINDLAY RD
BALTIMORE MD
21206-6410
US

V. Phone/Fax

Practice location:
  • Phone: 443-301-2148
  • Fax:
Mailing address:
  • Phone: 443-301-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: