Provider Demographics
NPI:1831198472
Name:CRAYCHEE, JUDITH ANNE (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:CRAYCHEE
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 1:5655 HUDSON DR STE 210
Mailing Address - Street 2:ARIS RADIOLOGY
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4455
Mailing Address - Country:US
Mailing Address - Phone:330-655-1869
Mailing Address - Fax:330-655-3828
Practice Address - Street 1:5655 HUDSON DR STE 210
Practice Address - Street 2:ARIS RADIOLOGY
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4455
Practice Address - Country:US
Practice Address - Phone:330-655-1869
Practice Address - Fax:330-655-3828
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1343862085P0229X
CAG822802085P0229X, 2085R0202X
ARE-54472085P0229X, 2085R0202X
CODR.00532962085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166420001Medicaid
AR5H034OtherBLUE CROSS
CA00G822800Medicaid
AR07110015100OtherQUAL CHOICE
AR5H034OtherBLUE CROSS
AR07110015100OtherQUAL CHOICE
WG82280EMedicare ID - Type Unspecified