MEDICARE: RICHARD TODD CRAWFORD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	PA258	KY
2	363AM0700X	Medical Physician Assistant	PA 258	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134123466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD TODD CRAWFORD PA-C

Provider Business Mailing Address
First Line	:	1760 NICHOLASVILLE RD
Second Line	:	STE 603
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1471
Country	:	US
Telephone Number	:	859-277-2211
Fax Number	:	859-277-7575

Provider Business Practice Location Address
First Line	:	1760 NICHOLASVILLE RD
Second Line	:	STE 603
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1471
Country	:	US
Telephone Number	:	859-277-3636
Fax Number	:	859-277-7575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/03/2020

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