Provider Demographics
NPI:1235457003
Name:DUFFY, CRYSTAL MICHELE (DO)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MICHELE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MICHELE
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:132 ABIGAIL LANE
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-5700
Practice Address - Country:US
Practice Address - Phone:814-272-7100
Practice Address - Fax:570-272-6501
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics