Provider Demographics
NPI:1285888305
Name:CRUM, EMILY MARIE (MAC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MARIE
Last Name:CRUM
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 DAVIDSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-2105
Mailing Address - Country:US
Mailing Address - Phone:410-721-4356
Mailing Address - Fax:
Practice Address - Street 1:903 REECE RD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1801
Practice Address - Country:US
Practice Address - Phone:443-534-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01215171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist