Provider Demographics
NPI:1629095088
Name:CROFT, PHILIP R (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:CROFT
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 1:36 TREMONT ST
Mailing Address - Street 2:# 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1223
Mailing Address - Country:US
Mailing Address - Phone:505-272-4422
Mailing Address - Fax:
Practice Address - Street 1:700 CAMINO DE SALUD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-9991
Practice Address - Country:US
Practice Address - Phone:505-272-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227939207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology