Provider Demographics
NPI:1245054311
Name:R. JOSEPH CRILL MD PA
Entity type:Organization
Organization Name:R. JOSEPH CRILL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-333-8897
Mailing Address - Street 1:9104 SHOREWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-7635
Mailing Address - Country:US
Mailing Address - Phone:313-333-8897
Mailing Address - Fax:
Practice Address - Street 1:9104 SHOREWOOD PL
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-7635
Practice Address - Country:US
Practice Address - Phone:313-333-8897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R. JOSEPH CRILL MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Single Specialty