Provider Demographics
NPI:1083833800
Name:CRAWFORD GREEN CARDIOLOGY GROUP LLC
Entity Type:Organization
Organization Name:CRAWFORD GREEN CARDIOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRAWFORD-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-567-5888
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-567-5888
Mailing Address - Fax:301-567-8040
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-567-5888
Practice Address - Fax:301-567-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027650207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011176600Medicaid
MD2160017OtherUHC PROVIDER NUMBER
MD4692961OtherCIGNA PROVIDER NUMBER
MD4692961OtherCIGNA PROVIDER NUMBER
DC011176600Medicaid