Provider Demographics
NPI:1508958539
Name:CRAWFORD, MEGAN MACGREGOR
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MACGREGOR
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:EDSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:9191 GRANT ST.
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-8812
Practice Address - Country:US
Practice Address - Phone:303-450-4482
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1843363AM0700X, 363AS0400X
COPA.0001843363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00608312OtherRAILROAD MEDICARE
CO47586851Medicaid
COP00608312OtherRAILROAD MEDICARE
COQ12277Medicare UPIN