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NPI Code Detail

MEDICARE: MR. JASON THOMAS CRUMP PAC

MEDICARE: MR. JASON THOMAS CRUMP PAC
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
1363A00000XPhysician Assistant021257NY
2363A00000XPhysician AssistantPA01297RI
3363A00000XPhysician Assistant0110002195VA
4363A00000XPhysician Assistant2338WV
5363A00000XPhysician AssistantPA9410MA
6363A00000XPhysician Assistant5102CT
7363A00000XPhysician AssistantPA1791ME

General Provider Information

NPI Number : 1104803170
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON THOMAS CRUMP PAC
Provider Business Mailing Address
First Line : 8517 CHAPIN ST
Second Line :
City : NORFOLK
State : VA
Zip : 23503-5501
Country : US
Telephone Number : 540-915-7195
Fax Number :
Provider Business Practice Location Address
First Line : 8517 CHAPIN STREET
Second Line :
City : NORFOLK
State : VA
Zip : 23503-4008
Country : US
Telephone Number : 540-915-7195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 07/24/2024

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Directions to “ MR. JASON THOMAS CRUMP PAC” Practice Location

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