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General NPI Number Information
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NPI Number | 1700193307
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Entity Type | Organization
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Legal Business Name | MELISSA C. CROOKSHANK MD LLC
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 829 SPRUCE ST SUITE 302
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5752
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Country | US
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Telephone | 215-829-5611
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Fax |
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Provider Business Mailing Address
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Address Line | 646 LINCOLN HWY SUITE 7
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City | FAIRLESS HILLS
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State | PA
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Zip | 19030-1410
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Country | US
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Telephone | 215-295-1717
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA CATHERINE CROOKSHANK
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Credential | M.D.
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Telephone | 215-829-5611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD437211
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License Number State | PA
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