Provider Demographics
NPI:1932248242
Name:CRUM, ROSA M (MD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:M
Last Name:CRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-614-0588
Practice Address - Street 1:2024 E MONUMENT ST
Practice Address - Street 2:SUITE 2-500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2217
Practice Address - Country:US
Practice Address - Phone:410-614-2411
Practice Address - Fax:410-614-0588
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD391452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD026692200Medicaid
MD167029YX3Medicare PIN