Provider Demographics
NPI:1376547273
Name:CRISP, ANGELA FAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:FAYE
Last Name:CRISP
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:31 ARNOT RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8533
Practice Address - Country:US
Practice Address - Phone:607-795-5182
Practice Address - Fax:607-795-5195
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271510207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3338858Medicare ID - Type Unspecified
LAF-32731Medicare UPIN