Provider Demographics
NPI:1245244789
Name:CRUTCHER, DEANGELA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:DEANGELA
Middle Name:LYNN
Last Name:CRUTCHER
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 1:3700 WASHINGTON AVE # 2200
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 WASHINGTON AVE
Practice Address - Street 2:STE 2200
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0541
Practice Address - Country:US
Practice Address - Phone:812-485-7111
Practice Address - Fax:812-485-7919
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057793A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64065568Medicaid
INP00647062OtherRAILROAD
IN200440270Medicaid
IN000000586024OtherANTHEM
IN200829650COtherMEDICAID GROUP
KY64065568Medicaid
KY64065568Medicaid