Provider Demographics
NPI:1538116041
Name:CRILLEY, PAMELA A (DO)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name:CRILLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:2 CAPITAL WAY STE 220
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2523
Practice Address - Country:US
Practice Address - Phone:609-303-0747
Practice Address - Fax:609-303-0771
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11267100207RH0003X
PA0S004378L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025078Medicaid
NJ2353601Medicaid
NJ2353601Medicaid
NJFC0906620OtherDEA