Provider Demographics
NPI:1730172966
Name:CREMEANS, LARRY T (DPM)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:T
Last Name:CREMEANS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5529
Mailing Address - Country:US
Mailing Address - Phone:740-345-6205
Mailing Address - Fax:
Practice Address - Street 1:21 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5529
Practice Address - Country:US
Practice Address - Phone:740-345-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001505213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCM000000116943OtherBCBS
OH0141448Medicaid
OH480032003Medicare ID - Type UnspecifiedRAILROAD
OH0141448Medicaid
OH0014071Medicare ID - Type Unspecified