Provider Demographics
NPI:1912967027
Name:CRAWFORD, CAMILLE R (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:R
Last Name:CRAWFORD
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 1:10032 DEMIA WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4734
Mailing Address - Country:US
Mailing Address - Phone:859-647-6700
Mailing Address - Fax:859-372-6362
Practice Address - Street 1:10032 DEMIA WAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-647-6700
Practice Address - Fax:859-372-6362
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051845208000000X
KY39520208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64045115Medicaid
OH0594441Medicaid