Individual
DALLAS PAYNE CRICKENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 725-1226
(540) 857-5306
Mailing address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 725-1226
(540) 857-5306
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101-017904
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097064000
MEDICAID OF WEST VIRGINIA
VA
01
—
1417921362
VIRGINIA HEALTH NETWORK
VA
05
—
1417921362
—
VA
01
—
371194700
BLACK LUNG
VA
01
—
540506332004
TRICARE/CHAMPUS
VA
01
—
P200030655
RAILROAD MEDICARE
VA
Enumeration date
02/16/2006
Last updated
03/10/2014
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