Provider Demographics
NPI:1093776502
Name:CRAWFORD, MICHAEL BRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRETT
Last Name:CRAWFORD
Suffix:
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 1:1202 BROWN STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4671
Mailing Address - Country:US
Mailing Address - Phone:252-946-0136
Mailing Address - Fax:252-946-0189
Practice Address - Street 1:1202 BROWN STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889
Practice Address - Country:US
Practice Address - Phone:252-946-0136
Practice Address - Fax:252-946-0189
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33637208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC25497OtherBCBS
NC7925407Medicaid
E04305Medicare UPIN
NC213618Medicare ID - Type Unspecified