Provider Demographics
NPI:1518945369
Name:CRAWFORD, CAROLYN S (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:CRAWFORD
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 1:5616 SOUNDS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEA ISLE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08243-1538
Mailing Address - Country:US
Mailing Address - Phone:609-827-3342
Mailing Address - Fax:
Practice Address - Street 1:1600 HADDON AVE
Practice Address - Street 2:ICN
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-757-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA034626002080N0001X
PAMD014055E2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2314509Medicaid
NJ2314509Medicaid