Provider Demographics
NPI:1659377018
Name:CRICKARD, KENT (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:CRICKARD
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 1:4510 MAIN STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-3057
Mailing Address - Fax:716-839-1477
Practice Address - Street 1:4510 MAIN STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-3057
Practice Address - Fax:716-839-1477
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118383207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5568Medicare ID - Type Unspecified
NYB71695Medicare UPIN