Individual
DR. ROLAND JEAN CREVECOEUR JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1800 N JUNIATA ST, HOLLIDAYSBURG, PA 16648-1997
(814) 695-1675
(814) 695-0632
Mailing address
1800 N JUNIATA ST, P O BOX 632, HOLLIDAYSBURG, PA 16648-1997
(814) 695-1675
(814) 695-0632
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD419870
PA
208000000X
Pediatrics Physician
Primary
MD-419870
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001922333
—
PA
01
—
110094
LEGACY PIN
PA
01
—
P00432632
RR PIN
PA
Enumeration date
09/16/2006
Last updated
01/20/2012
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