Provider Demographics
NPI:1396164117
Name:COX CRAYTON, ANGEL (DPM)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:COX CRAYTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-0301
Mailing Address - Country:US
Mailing Address - Phone:302-762-0200
Mailing Address - Fax:302-762-0500
Practice Address - Street 1:4011 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2219
Practice Address - Country:US
Practice Address - Phone:302-762-0200
Practice Address - Fax:302-762-0500
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006436213E00000X
DEE1-0000220213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA448690ZRQ4OtherMEDICARE
DE399633ZQ6GOtherMEDICARE