Individual
DR. AMANDA RENAE CRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D, M.S
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 614-5115
Mailing address
PO BOX 64481, BALTIMORE, MD 21264-4481
(410) 614-5115
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
5961
OH
152W00000X
Optometrist
Primary
TA2276
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049414300
—
MD
Enumeration date
07/08/2010
Last updated
06/09/2017
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