Provider Demographics
NPI:1811053739
Name:CRUM, THOMAS ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALAN
Last Name:CRUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COLISEUM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5975
Mailing Address - Country:US
Mailing Address - Phone:757-736-8050
Mailing Address - Fax:
Practice Address - Street 1:4000 COLISEUM DR STE 200
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5975
Practice Address - Country:US
Practice Address - Phone:757-736-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007760103G00000X
FLPY6720103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107559100Medicaid
FL73083ZMedicare ID - Type UnspecifiedMEDICARE
FLQ02823Medicare UPIN