Provider Demographics
NPI:1669990016
Name:CROUSE, ZACHARY DANIEL
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DANIEL
Last Name:CROUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7036 GEHR RD
Mailing Address - Street 2:
Mailing Address - City:SAINT THOMAS
Mailing Address - State:PA
Mailing Address - Zip Code:17252-9501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13115 DICKEYS RD
Practice Address - Street 2:
Practice Address - City:MERCERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17236-9684
Practice Address - Country:US
Practice Address - Phone:717-369-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABVO-14019208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice