Healthcare Provider Details

I. General information

NPI: 1629095088
Provider Name (Legal Business Name): PHILIP R CROFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CAMINO DE SALUD NE
ALBUQUERQUE NM
87131-9991
US

IV. Provider business mailing address

36 TREMONT ST # 2
CAMBRIDGE MA
02139-1223
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4422
  • Fax:
Mailing address:
  • Phone: 505-272-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number227939
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: