Provider Demographics
NPI:1124026257
Name:CRAWFORD, ANDREA BACH (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:BACH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:7584 HOSPITAL DR
Practice Address - Street 2:BLDG.C SUITE 202
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4178
Practice Address - Country:US
Practice Address - Phone:804-693-4645
Practice Address - Fax:804-693-5985
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-05-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
VA0101032226207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124026257Medicaid
VA1124026257Medicaid
VAP00670732Medicare PIN
VA018481R53Medicare PIN