MEDICARE: MR. IAN CLOID CRAWFORD NP-BC

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	363L00000X	Nurse Practitioner	0024187755	VA

General Provider Information

NPI Number	:	1972280048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IAN CLOID CRAWFORD NP-BC

Provider Business Mailing Address
First Line	:	1401 TURNMILL DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5566
Country	:	US
Telephone Number	:	804-401-0807
Fax Number	:

Provider Business Practice Location Address
First Line	:	7607 FOREST AVE STE 220
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4913
Country	:	US
Telephone Number	:	804-285-9416
Fax Number	:

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

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	08/10/2023

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