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NPI Code Detail

MEDICARE: DR. ANGELA FAYE CRISP M.D.

MEDICARE: DR. ANGELA FAYE CRISP M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician271510NY

General Provider Information

NPI Number : 1376547273
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA FAYE CRISP M.D.
Provider Business Mailing Address
First Line : 1 GUTHRIE SQ
Second Line :
City : SAYRE
State : PA
Zip : 18840-1625
Country : US
Telephone Number : 570-888-5858
Fax Number :
Provider Business Practice Location Address
First Line : 31 ARNOT RD
Second Line :
City : HORSEHEADS
State : NY
Zip : 14845-8533
Country : US
Telephone Number : 607-795-5182
Fax Number : 607-795-5195
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 09/05/2013

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