Provider Demographics
NPI:1578560819
Name:CRISPINO, CHARLES M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:CRISPINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5750 CENTRE AVE
Mailing Address - Street 2:STE 510
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3721
Mailing Address - Country:US
Mailing Address - Phone:412-661-6770
Mailing Address - Fax:412-661-7022
Practice Address - Street 1:5750 CENTRE AVE
Practice Address - Street 2:STE 510
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3721
Practice Address - Country:US
Practice Address - Phone:412-661-6770
Practice Address - Fax:412-661-7022
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDMD024673E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060034769OtherPALMETTO RR
100955Medicare ID - Type Unspecified
B36418Medicare UPIN