Provider Demographics
NPI:1629169974
Name:CREWS, JOHN EVERETT III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EVERETT
Last Name:CREWS
Suffix:III
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 1:655 W PARK LN
Mailing Address - Street 2:SUITE 655
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3712
Mailing Address - Country:US
Mailing Address - Phone:267-573-9705
Mailing Address - Fax:215-531-8066
Practice Address - Street 1:655 W PARK LN
Practice Address - Street 2:SUITE 655
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3712
Practice Address - Country:US
Practice Address - Phone:267-573-9705
Practice Address - Fax:215-531-8066
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431004208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001940161OtherBLUE CROSS NE PA
PA2165989OtherUNITED HEALTHCARE
PA7632300OtherAETNA
PAP00759527OtherMEDICARE RAILROAD
PA1018895810001Medicaid
PA106959OtherGEISINGER
PA821627OtherFIRST PRIORITY HEALTH
PA001955909OtherMEDICARE ADVANTAGE PPO
PA1955909OtherBLUE SHIELD
VA7308884Medicaid
PA7632300OtherAETNA
VA7308884Medicaid
PA1018895810001Medicaid
VAH52258Medicare UPIN