Provider Demographics
NPI:1821809328
Name:CRUTCHFIELD, CONNOR R (BA)
Entity type:Individual
Prefix:MR
First Name:CONNOR
Middle Name:R
Last Name:CRUTCHFIELD
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6703
Mailing Address - Country:US
Mailing Address - Phone:603-568-1112
Mailing Address - Fax:
Practice Address - Street 1:1015 WALNUT STREET
Practice Address - Street 2:CURTIS BUILDING, SUITE 115
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5005
Practice Address - Country:US
Practice Address - Phone:603-568-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program