Provider Demographics
NPI:1366477952
Name:MCCRUMB, FRED R (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:R
Last Name:MCCRUMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5982
Mailing Address - Fax:585-756-0169
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5982
Practice Address - Fax:585-756-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY194754207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000912498002OtherBS WNY/HEALTHNOW
NY050063378OtherRAILROAD MEDICARE
NYG0189393590OtherBLUE CHOICE GROUP
NYP010194754OtherBLUE CHOICE
NY5387458OtherAETNA
NY2222OtherBLUE SHIELD GROUP
NY00372225Medicaid
NY01665241Medicaid
NY00025524501OtherUNIVERA
NYMDC633OtherPREFERRED CARE
NY5399003OtherGHI
NY00025524501OtherUNIVERA