Provider Demographics
NPI:1609822121
Name:CRISAN-DUMA, CRINA (MD)
Entity type:Individual
Prefix:
First Name:CRINA
Middle Name:
Last Name:CRISAN-DUMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRINA
Other - Middle Name:
Other - Last Name:CRISAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4525 THOMASSON DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6962
Mailing Address - Country:US
Mailing Address - Phone:239-354-6500
Mailing Address - Fax:
Practice Address - Street 1:4525 THOMASSON DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6962
Practice Address - Country:US
Practice Address - Phone:239-354-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8371171Medicaid
WAAB39880Medicare PIN
WA8371171Medicaid