Healthcare Provider Details

I. General information

NPI: 1295350486
Provider Name (Legal Business Name): RICHARD MOHAMMED CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 04/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 TRENTON RD
LEVITTOWN PA
19056-1445
US

IV. Provider business mailing address

2346 TRENTON RD STE C
LEVITTOWN PA
19056-1445
US

V. Phone/Fax

Practice location:
  • Phone: 215-945-1800
  • Fax:
Mailing address:
  • Phone: 267-975-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022765
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: