Provider Demographics
NPI:1720034036
Name:CRALEY, KEITH A (PA-C)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:CRALEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 E RACE ST
Mailing Address - Street 2:LOWER LEVEL, REAR
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-9587
Mailing Address - Country:US
Mailing Address - Phone:484-223-3412
Mailing Address - Fax:484-223-3419
Practice Address - Street 1:1540 E RACE ST
Practice Address - Street 2:LOWER LEVEL, REAR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9587
Practice Address - Country:US
Practice Address - Phone:484-223-3412
Practice Address - Fax:484-223-3419
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ02816Medicare UPIN
PA075298F06Medicare ID - Type Unspecified