Provider Demographics
NPI:1154649234
Name:CRAWFORD, MICHELLE CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CHRISTINE
Other - Last Name:MERGENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1930 MARLTON PIKE E STE C15
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2143
Mailing Address - Country:US
Mailing Address - Phone:856-509-5063
Mailing Address - Fax:856-509-5064
Practice Address - Street 1:1930 MARLTON PIKE E STE C15
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2143
Practice Address - Country:US
Practice Address - Phone:856-509-5063
Practice Address - Fax:856-509-5064
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA105942002084P0800X
PAMT197315390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry