Provider Demographics
NPI:1760450621
Name:CRAWFORD, ERIC K (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:K
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 DAYBREAK CIR
Mailing Address - Street 2:A150-208
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1642
Mailing Address - Country:US
Mailing Address - Phone:443-717-1867
Mailing Address - Fax:
Practice Address - Street 1:6030 DAYBREAK CIR
Practice Address - Street 2:A150-208
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1642
Practice Address - Country:US
Practice Address - Phone:443-717-1867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM45325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD695863Medicare UPIN