Provider Demographics
NPI:1790195675
Name:CRABTREE, HEATHER FENLEY (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:FENLEY
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 S BENZING RD STE C
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1741
Mailing Address - Country:US
Mailing Address - Phone:215-300-2577
Mailing Address - Fax:
Practice Address - Street 1:3670 S BENZING RD STE C
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1741
Practice Address - Country:US
Practice Address - Phone:215-300-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73244207Y00000X
390200000X
NY318450-01207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program