Provider Demographics
NPI:1609077007
Name:CRAWFORD, CHERYL ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANNE
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 1:204 W PINE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLAUS
Mailing Address - State:IN
Mailing Address - Zip Code:47579-6112
Mailing Address - Country:US
Mailing Address - Phone:812-544-2821
Mailing Address - Fax:812-544-2971
Practice Address - Street 1:204 W PINE DR
Practice Address - Street 2:
Practice Address - City:SANTA CLAUS
Practice Address - State:IN
Practice Address - Zip Code:47579-6112
Practice Address - Country:US
Practice Address - Phone:812-544-2821
Practice Address - Fax:812-544-2971
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030357251G00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251G00000XAgenciesHospice Care, Community Based
Not Answered251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC31790Medicare UPIN
IN890310Medicare ID - Type Unspecified