Provider Demographics
NPI:1619227931
Name:CRUTCHFIELD, RACHEL C (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:C
Last Name:CRUTCHFIELD
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 1:19 GREEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2654
Mailing Address - Country:US
Mailing Address - Phone:540-885-8143
Mailing Address - Fax:
Practice Address - Street 1:19 GREEN HILLS DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2654
Practice Address - Country:US
Practice Address - Phone:540-885-8143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101261877208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1619227931Medicaid