Healthcare Provider Details

I. General information

NPI: 1740326412
Provider Name (Legal Business Name): DEIDRA C. CREWS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E MONUMENT ST 1830 BUILDING, 4TH FLOOR
BALTIMORE MD
21205-2100
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5268
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD66025
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: