MEDICARE: DR. MICHAEL CROCETTI 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	208000000X	Pediatrics Physician	D50569	MD

Other Identifiers

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

General Provider Information

NPI Number	:	1255371399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL CROCETTI M.D.

Provider Business Mailing Address
First Line	:	9910 FRANKLIN SQUARE DR STE 2110
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21236-4902
Country	:	US
Telephone Number	:	410-933-5412
Fax Number	:

Provider Business Practice Location Address
First Line	:	JHCP CANTON CROSSING - 1501 S. CLINTON ST
Second Line	:	SUITE #200
City	:	BALTIMORE
State	:	MD
Zip	:	21224
Country	:	US
Telephone Number	:	410-522-9940
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/24/2018

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