Provider Demographics
NPI:1538238332
Name:HARRY S CRAWFORD III MD PLC
Entity type:Organization
Organization Name:HARRY S CRAWFORD III MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:STEPHENSON
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:540-828-2529
Mailing Address - Street 1:114 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1132
Mailing Address - Country:US
Mailing Address - Phone:540-828-2529
Mailing Address - Fax:540-828-7429
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1132
Practice Address - Country:US
Practice Address - Phone:540-828-2529
Practice Address - Fax:540-828-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA253364OtherSOUTHERN HEALTH
VA173944OtherANTHEM
VA173944OtherANTHEM