Healthcare Provider Details

I. General information

NPI: 1114138609
Provider Name (Legal Business Name): CHITO M. CRUDO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FAYETTE STREET
BELLE VERNON PA
15012-1666
US

IV. Provider business mailing address

PO BOX 251
BELLE VERNON PA
15012-0251
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-4122
  • Fax: 724-929-5188
Mailing address:
  • Phone: 724-929-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD035941L
License Number StatePA

VIII. Authorized Official

Name: DR. CHITO M CRUDO
Title or Position: OWNER
Credential: MD
Phone: 724-929-4122