Provider Demographics
NPI:1083612931
Name:CROW, WILLIAM C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:CROW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2323 MEMORIAL AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2661
Practice Address - Country:US
Practice Address - Phone:434-200-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005614074Medicaid
44989OtherSENTARA/OPTIMA PROVIDER N
60814OtherMEDCOST PROVIDER NUMBER
VA005614066Medicaid
01-02055OtherUNITED HEALTHCARE PROVIDE
080384OtherANTHEM PROVIDER NUMBER
248761OtherSOUTHERN HEALTH PROVIDER
56-1407-4OtherVA PREMIER PROVIDER NUMBE
541457983OtherPCHP PROVIDER NUMBER
700010623OtherCIGNA PROVIDER NUMBER
541457983OtherTRICARE PROVIDER NUMBER
56-1406-6OtherVA PREMIER PROVIDER NUMBE
541457983OtherPCHP PROVIDER NUMBER
56-1407-4OtherVA PREMIER PROVIDER NUMBE
541457983OtherTRICARE PROVIDER NUMBER