Healthcare Provider Details

I. General information

NPI: 1861490500
Provider Name (Legal Business Name): MICHAEL E CROUCH MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PINE BLUFF RD SUITE 7
SALISBURY MD
21801-7160
US

IV. Provider business mailing address

105 PINE BLUFF RD SUITE 7
SALISBURY MD
21801-7160
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-3243
  • Fax: 410-546-2926
Mailing address:
  • Phone: 410-546-3243
  • Fax: 410-546-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD26612
License Number StateMD

VIII. Authorized Official

Name: DR. MICHAEL EDWARD CROUCH
Title or Position: PRESIDENT
Credential: MD
Phone: 410-546-3243