Organization
PENNSYLVANIA CENTRE FOR DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN H CRAWFORD MD (PRESIDENT)
(267) 519-0154
Entity
Organization
Contact information
Practice address
822 PINE ST, SUITE 2A, PHILADELPHIA, PA 19107-6187
(267) 519-0154
(267) 519-0597
Mailing address
PO BOX 22624, PHILADELPHIA, PA 19110-2624
(267) 519-0154
(267) 519-0597
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD421221
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1607671
HIGHMARK BLUE SHIELD
PA
01
—
2295672000
IBC
—
01
—
3679792
AETNA
PA
Enumeration date
08/30/2006
Last updated
10/04/2011
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