Provider Demographics
NPI:1538143482
Name:CRAWFORD, GLEN D (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:D
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LAFAYETTE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5679
Mailing Address - Country:US
Mailing Address - Phone:603-431-1121
Mailing Address - Fax:603-431-9147
Practice Address - Street 1:1900 LAFAYETTE RD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5679
Practice Address - Country:US
Practice Address - Phone:603-431-1121
Practice Address - Fax:603-431-9147
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73568207X00000X
NH14791207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004551Medicaid
MA3072151Medicaid
MAE68814Medicare UPIN
NH001574401Medicare UPIN
MA3072151Medicaid