Provider Demographics
NPI:1720188683
Name:CRAWFORD, PETER J (PA-C)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:26 GAIL CT
Practice Address - Street 2:SUITE 2B
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3486
Practice Address - Country:US
Practice Address - Phone:973-940-3137
Practice Address - Fax:973-940-3140
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00383OtherPA-C LICENSE NUMBER