Healthcare Provider Details

I. General information

NPI: 1982680294
Provider Name (Legal Business Name): GLEN COLLIER CRAWFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 1000
FPO AE
09617
US

IV. Provider business mailing address

PSC 827 BOX 152
FPO AE
09617
US

V. Phone/Fax

Practice location:
  • Phone: 202-468-2821
  • Fax:
Mailing address:
  • Phone: 202-468-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number80080
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number80080
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number80080
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: