Provider Demographics
NPI:1902986292
Name:CRICHLOW, BRIAN R (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:CRICHLOW
Suffix:
Gender:M
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 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3134
Mailing Address - Country:US
Mailing Address - Phone:252-537-8193
Mailing Address - Fax:252-537-0589
Practice Address - Street 1:204 BECKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3134
Practice Address - Country:US
Practice Address - Phone:252-537-8193
Practice Address - Fax:252-537-0589
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236455207W00000X
NC200400660207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010089701Medicaid
VA146403OtherANTHEM BCBS
VA146404OtherANTHEM BCBS
VA010311063Medicaid
NC137UEOtherBCBS OF NC
NC89137UEMedicaid
I07378OtherUPIN
0347580002Medicare NSC
VAP00362849Medicare PIN
NC2028024Medicare PIN
VA146404OtherANTHEM BCBS
NC137UEOtherBCBS OF NC