Individual
BRIAN DALE CRISPELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1078 W BALTIMORE PIKE, RIDDLE HEALTH CENTER 1, SUITE 209, MEDIA, PA 19063-5105
(610) 334-7657
Mailing address
2301 GREEN ST, APT 8, PHILADELPHIA, PA 19130-3143
(610) 334-7657
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
SC005698
PA
213EP1101X
Primary Podiatric Medicine Podiatrist
SC005698
PA
213ES0000X
Sports Medicine Podiatrist
SC005698
PA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC005698
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015531700005
—
PA
01
—
329832
MEDICARE PTAN
PA
Enumeration date
03/27/2006
Last updated
06/13/2014
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