Provider Demographics
NPI:1467789669
Name:CRAWFORD, HEATHER (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:CRAWFORD-GILLISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:1600 HADDON AVE
Practice Address - Street 2:L&D
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-757-3786
Practice Address - Fax:856-365-7865
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08651500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0280551Medicaid
NJ289539C04Medicare PIN