MEDICARE: TIMOTHY CRISCI MD

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
1	207RP1001X	Pulmonary Disease Physician	MD477908	PA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MD477908	PA
3	208000000X	Pediatrics Physician	MD477908	PA
4	207R00000X	Internal Medicine Physician	MD477908	PA

General Provider Information

NPI Number	:	1538666243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY CRISCI MD

Provider Business Mailing Address
First Line	:	1991 SPROUL RD STE 130
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-3512
Country	:	US
Telephone Number	:	484-421-1669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1991 SPROUL RD STE 130
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-3512
Country	:	US
Telephone Number	:	484-421-1669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	06/10/2026

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