Provider Demographics
NPI:1356073688
Name:CRABTREE, CORY ALAN (PA)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:ALAN
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6104
Mailing Address - Country:US
Mailing Address - Phone:434-579-0064
Mailing Address - Fax:
Practice Address - Street 1:300 SUSSEX ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6104
Practice Address - Country:US
Practice Address - Phone:434-579-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant