Provider Demographics
NPI:1447213863
Name:CRAWFORD, HEATHER (DPM)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E MAIN ST
Mailing Address - Street 2:UNIT 4D
Mailing Address - City:LITTLE EGG HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-2669
Mailing Address - Country:US
Mailing Address - Phone:609-296-3533
Mailing Address - Fax:
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:UNIT 4D
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-2669
Practice Address - Country:US
Practice Address - Phone:609-296-3533
Practice Address - Fax:609-296-4742
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00248400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7783001Medicaid
NJD07456800OtherCDS
NJD07456800OtherCDS
019484Medicare ID - Type Unspecified
BC5985431OtherDEA