Provider Demographics
NPI:1790857456
Name:CRAWFORD, CHRISTOPHER R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:CRAWFORD
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 1:1721 EBENEZER RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4103
Mailing Address - Country:US
Mailing Address - Phone:803-328-1919
Mailing Address - Fax:803-328-1818
Practice Address - Street 1:1721 EBENEZER RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-4103
Practice Address - Country:US
Practice Address - Phone:803-328-1919
Practice Address - Fax:803-328-1818
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMPA963Medicaid
SCE37273Medicare UPIN
SCE372734261Medicare ID - Type Unspecified